antibioticsThe Scottish Medicines Consortium (SMC) has accepted six new medicines for routine use by NHS Scotland.

Osimertinib (Tagrisso) was accepted for the treatment of non-small cell lung cancer following consideration through the SMC’s Patient and Clinician Engagement (PACE) process for medicines used to treat end of life and very rare conditions. The PACE meeting heard that osimertinib is better tolerated than other current treatments and is taken orally, factors that can allow patients to lead more normal lives and possibly return to work.

Also accepted through the PACE process was Everolimus (Afinitor), which is used for the treatment of a rare type of tumour that develops in the lungs or intestine. In the PACE meeting, patient groups highlighted that current treatment options are limited and there is no other proven effective therapy for use in the later stages of the disease. Everolimus can offer patients a valuable delay in time to disease progression with the potential to extend survival. It also has the advantage of being an oral therapy that can be taken at home.

Also accepted following consideration through the PACE process was trifluridine/tipiracil (Lonsurf), for the treatment of advanced colorectal cancer in patients who have already undergone several other treatments. Trifluridine/tipiracil is an oral treatment with manageable side effects, and may offer patients an additional two months survival, which is important in the context of limited remaining time.

Botulinum toxin type A (Botox) was accepted for the treatment of chronic migraine in the group of patients who experience headaches on at least 15 days a month and who have been unsuccessfully treated with the other therapy options available. In addition to severe headache, patients with chronic migraine may experience symptoms including nausea and/or vomiting, diarrhoea, hypersensitivity to light, sound and smell and visual disturbances. This combination of symptoms can significantly impact on daily life. There are currently limited treatment options for these patients and botulinum toxin type A can help reduce the number of days in which they experience headache. 

The Committee accepted evolocumab (Repatha) for routine use to lower cholesterol levels in patients at high cardiovascular risk in whom standard drug therapy has not lowered cholesterol levels adequately. Evolocumab will be prescribed by specialists and is administered by fortnightly injections. 

Also accepted for routine use was iron (III) isomaltoside 1000 (Diafer) for the treatment of iron deficiency in patients with chronic kidney disease who are on dialysis. Iron (III) isomaltoside 1000 provides another treatment option for patients with this condition.

Rejected drug

The Committee was unable to accept desmospressin oral lyophilisate (Noqdima) for the treatment of idiopathic nocturnal polyuria, a condition where people need to pass urine frequently during the night. The Committee was not satisfied that the company’s evidence about the benefits of the medicine was strong enough to justify its cost to the NHS. 

Professor Jonathan Fox, chairman of the SMC, said: “We are pleased to be able to accept these six new medicines for routine use in NHS Scotland. Through the valuable testimonies provided by patient groups and clinicians at our PACE meeting, we know that osimertinib will be welcomed as it can enable patients to live more normal daily lives. 

“Everolimus provides a treatment option for a condition at a stage where there is currently no other proven effective therapy, while the potential additional survival time offered by trifluridine/tipiracil will be of value to patients and their families alike. 

“For those suffering with chronic migraine for which other treatments have not been effective, botulinum toxin type A (Botox) fulfils an unmet need. Evolocumab belongs to a new class of medicines that lower cholesterol and is expected to benefit patients who cannot be managed effectively with current treatments. Iron (III) isomaltoside 1000 offers clinicians and patients another treatment option for iron deficiency in patients with chronic kidney disease on dialysis.

“The Committee was unable to accept desmospressin oral lyophilisate. Unfortunately, the company’s evidence on the benefits of the medicine did not convince us that it would be a good use of NHS resources.”

Further details of all medicines can be found at