SMC approves six drugs

On 7 March 2011, the Scottish Medicines Consortium (SMC) accepted the following six medicines for use within the Scottish NHS:

* Botulinum toxin A [Botox] has been accepted for use in patients with focal spasticity of the wrist and hand associated with stroke.1

* The SMC has accepted fosaprepitant dimeglumine [IVEmend 150mg] for the prevention of acute and delayed cisplatin-based chemotherapy-induced nausea and vomiting.2 This recommendation is for highly, but not moderately, emetogenic chemotherapy.

* Dalteparin sodium [Fragmin] also received a recommendation for restricted use as an extended treatment of venous thromboembolism (VTE), and prevention of its recurrence in patients with solid tumours.3 This treatment has to be initiated by a healthcare professional with experience in treating VTE.

* Exenatide [Byetta] has been accepted for use in patients with type 2 diabetes mellitus.4 Treatment is restricted to use in combination with metformin and a thiazolidinedione as third-line therapy (prior to initiating insulin therapy).

* Paxopanib [Votrient] has been accepted for the treatment of advanced renal cell carcinoma, both as first-line therapy and for patients who have received prior cytokine for advanced disease.5 This advice is dependent on the continued availability of a Patient Access Scheme, say the SMC.

* Finally, sildenafil 0.8 mg/mL injection [Revatio] has been accepted for restricted use in patients with pulmonary arterial hypertension who are temporarily unable to take oral sildenafil.6 Advice of a specialist from the Scottish Pulmonary Vascular Unit or the Scottish Adult Congenital Cardiac Services is needed for the use of this treatment. Significantly more costly than oral sildenafil, this IV formulation is intended for short-term use (about three days).

But fails to recommend two more

However, two other products have failed to gain recommendation from the SMC:

* Adapalene/benzoyl peroxide 0.1%/2.5% gel [Epiduo] has not been recommended for use in patients with acne vulgaris when comedones, papules and pustules are present.7 The SMC says that Galderma failed to present sufficiently robust economic data to grant acceptance.

* Vinflunine [Javlor] has also failed to be recommended as a treatment for advanced or metastatic transitional cell carcinoma of the urothelial tract in patients who have previously failed platinum-based therapy - because the cost of treatment in relation to the clinical benefit was insufficient.8

[Reference]

1. Scottish Medicines Consortium.Clostridium botulinum type A neurotoxin (Botox). Internet Document: [1 pages], 7 Mar 2011. Available from: URL: http://www.scottishmedicines.org.uk. .

2. Scottish Medicines Consortium.Fosaprepitant dimeglumine (IVEmend 150mg). Internet Document: [1 pages], 7 Mar 2011. Available from: URL: http://www.scottishmedicines.org.uk. .

3. Scottish Medicines Consortium.Dalteparin (Fragmin). Internet Document: [1 pages], 7 Mar 2011. Available from: URL: http://www.scottishmedicines.org.uk. .

4. Scottish Medicines Consortium.Exenatide (Byetta). Internet Document: [1 pages], 7 Mar 2011. Available from: URL: http://www.scottishmedicines.org.uk. .

5. Scottish Medicines Consortium.Pazopanib (Votrient). Internet Document: [1 pages], 7 Mar 2011. Available from: URL: http://www.scottishmedicines.org.uk. .

6. Scottish Medicines Consortium.Sildenafil (Revatio) IV. Internet Document: [1 pages], 7 Mar 2011. Available from: URL: http://www.scottishmedicines.org.uk. .

7. Scottish Medicines Consortium.Adapalene 0.1%/benzoyl peroxide 2.5% gel (Epiduo(Rm)). Internet Document: [2 pages], 7 Mar 2011. Available from: URL: http://www.scottishmedicines.org.uk. .

8. Scottish Medicines Consortium.Vinflunine ditartrate (Javlor). Internet Document: [1 pages], 7 Mar 2011. Available from: URL: http://www.scottishmedicines.org.uk. .