Monthly News Update: Scotland Edition: January/February 2025

ScriptSwitch™ Monthly Summary: Scotland edition – January/February 2025

Welcome to the KINES Scotland Monthly News Update for January/February 2025. Other KINES Rapid Updates published this month have discussed the following (ScriptSwitch users, please login or register to access KINES articles online):

  • A large systematic review and network meta-analysis (NMA), including 113 randomised controlled trials and 14,887 participants, looked at the efficacy of pharmacological and non-pharmacological therapies for the management of ADHD in adults. The primary outcomes were efficacy (change in ADHD core symptom severity on self-rated and clinician-rated scales at timepoints closest to 12 weeks) and acceptability (all-cause discontinuation). The study found evidence for 50 treatments: pharmacological therapies, psychological therapies, neurostimulatory therapy, neurofeedback and control conditions. In the short term (12 weeks) only pharmacological therapies (atomoxetine, lisdexamfetamine, methylphenidate) showed any benefit for the change in ADHD core symptom severity on both self-reported and clinician-reported scales. Cognitive behavioural therapy, cognitive remediation, mindfulness, psychoeducation and transcranial direct current stimulation were better than placebo only on clinician-reported measures in the short term. In terms of acceptability, atomoxetine and guanfacine were found to be worse than placebo and all pharmacological treatments had worse tolerability than placebo.
  • A randomised controlled trial has assessed the effectiveness of a brief rehabilitation program based on a cognitive and behavioural approach in people aged over 16 years with mild to moderate long COVID (post-COVID-19 syndrome). A range of self-report measures were completed by participants focusing on symptoms, physical functioning, and distress, and the primary outcome was the physical functioning subscale of the Short-Form Health Survey 36 (SF-36-PFS). The study found that the SF-36-PFS scores improved significantly more in the rehabilitation group than in the usual care group after treatment had finished and at follow-up (12 months after enrolment). Most other measures of functional capability and symptom scores also favoured the intervention group with small to moderate effect sizes. Smell and/or taste difficulties and bodily pain were the only outcome measures with no statistically significant effect at any time point.

KINES Scotland Update:

  • National Therapeutic Indicators have been updated with data to September 2024. PHS have highlighted prescribing of valproate to women aged under 55. There has been a decline in prescribing over the last three years nationally, however, considerable variation remains between health boards.
  • The GPhC has amended the list of high risk medicines which require independent verification of patient-provided information, relating to medicines used for weight management. Before providing medicines for weight-management, the prescriber now has to independently verify the person’s weight, height and/or body mass index, to support safer decision making and ensure that the supply is appropriate for the person.
  • SIGN is requesting input into the scope of a forthcoming guideline on management of obesity.
  • The Scottish Practice Pharmacy & Prescribing Advisers (SP3A) annual conference for 2025 will take place in Glasgow on Friday 7 November 2025. Abstract submission and registration will open in the summer.
  • The UK Pharmacy Professional Leadership Advisory Board is hosting a number of interactive webinars across February, with the aim of shaping pharmacy professional leadership for the future. This work is in support of the recommendations within the UK Commission on Pharmacy Professional Leadership’s report from 2023.
  • PHS’s Rapid Action Drug Alerts and Response (RADAR) team have issued a quarterly update. This includes information on recent legal status changes to nitazene-type opioids, xylazine and bromazolam.
  • PHS have also issued the latest Scottish Vaccine Update, focussed on sexual health vaccine programmes. It includes links to a range of education materials aimed at clinicians, concise links to national guidance and PGDs, and a summary of the supply position.
  • A recording of the British Thoracic Society, NICE and SIGN winter meeting is available, which includes presentations and a Q&A on the Joint Guideline for the Diagnosis, Monitoring and Management of Chronic Asthma.

Update from NICE:

  • New guidance on Overweight and obesity management (NG246) consolidates previous clinical and public health guidance into one document. It includes measures for prevention of obesity, overweight and central adiposity, as well as assessment and referral criteria. It covers physical activity and diet, as well as medicinal and surgical options and the use of digital technologies for delivering multidisciplinary weight management services. Finally, it looks at the delivery and evaluation of services and interventions. Medicinal options (alongside a reduced-calorie diet and increased physical exercise) include tirzepatide, semaglutide, liraglutide or orlistat.
  • The guidance on the use of Andexanet alfa for reversing anticoagulation from apixaban or rivaroxaban (TA697) has been updated with the note that a recommendation on its use for reversing anticoagulation in people with intracranial haemorrhage cannot be made in the absence of an evidence submission from the manufacturer.
  • The guidance on Epilepsies in children, young people and adults (NG217) has been updated in line with MHRA guidance on the use of valproate in people under 55 years, and in men. MHRA guidance on topiramate has also been added – that it should not be used in women and girls of childbearing potential unless the conditions of the Pregnancy Prevention Programme are fulfilled.

DHSE/UKHSA/NHS England:

  • This month, NHS England have published a self-assessment toolkit for integrated care boards (ICBs) on antimicrobial stewardship. ICBs are responsible for:
    • identifying an antimicrobial resistance lead with overall responsibility for co-ordinating the ICB’s antimicrobial resistance response and with a clear position in the ICB’s governance structure
    • developing an understanding of infection and antimicrobial prescribing trends, of variation in their localities, and therefore of where action should be focussed
    • addressing the issues in their areas and supporting national plans
    • developing pathway-based approaches across primary and secondary care
    • ensuring that antimicrobial resistance forms part of the ICB prevention plans and that there is an integrated approach to individuals and communities at greater risk of ill-health
    • supporting place-based partnerships and primary care networks to identify actions to address antimicrobial resistance

Other:

  • Following concerns of an increased risk of non-arteritic anterior ischemic optic neuropathy (NAION), the European PRAC (Pharmacovigilance Risk Assessment Committee) has initiated a review of semaglutide-containing medicines. NAION is a disorder caused by reduced blood flow to the optic nerve in the eye with potential damage to the nerve, which can lead to loss of vision in the affected eye. Patients with type 2 diabetes might already have an inherently higher risk of developing this condition.
  • The Medicines and Healthcare products Regulatory Agency (MHRA) has approved aprocitentan (Jeraygo) to treat resistant hypertension (blood pressure inadequately controlled by at least three other medicines) in adults. The recommended daily dose is 12.5 to 25 mg as an adjunct to at least three antihypertensive medicinal products.

Medicines Update:

Medicines supply notifications

  • Xylocaine® (lidocaine) 10mg is out of stock until mid-February 2025.
    • Lidocaine 5% / Phenylephrine 0.5% spray and Lidocaine 50mg/g / Cetrimide 1.5mg/g (Xylonor Gel) remain available and can support an increase in demand.
    • Lidocaine 150mg/g / Cetrimide 1.5mg/g (Xylonor®) oromucosal spray remains available but cannot support an increase in demand.
  • Apomorphine hydrochloride (APO-go® PFS) 50mg/10ml solution for infusion pre-filled syringes are being discontinued. Supplies are anticipated to be exhausted by April 2025.
    • APO-go® POD (apomorphine hydrochloride hemihydrate) 100mg/20ml solution for infusion cartridges remain available and can support increased demand.
  • Hydrocortisone sodium phosphate 100mg/1ml solution for injection ampoules are in limited supply, with stock exhaustion anticipated by March 2025. The anticipated resupply is May 2026.
    • Hydrocortisone sodium succinate 100mg powder for solution for injection/infusion remains available and can support an increase in demand. After reconstitution with 2ml diluent, the final concentration is approximately 50mg/ml.
  • Memantine (Valios®) 5mg orodispersible tablets sugar free are out of stock until late April 2025. Other memantine formulations are available and can support an increase in demand:
    • Memantine (Valios®) 10mg and 20mg orodispersible tablets sugar free
    • Memantine 5 mg/10 mg/15 mg/20 mg tablets treatment initiation pack (note: film-coated tablets)
    • Memantine 10mg/ml oral solution sugar free and memantine (Ebixa®) 5mg/0.5ml pump actuation oral solution
    • Memantine 10mg and 20mg film coated tablets

Important New Evidence is produced by Optum as part of the ScriptSwitch Medicines Management Bulletin in partnership with The Centre for Medicines Optimisation at Keele University. The views expressed are Keele’s and may not reflect local prescribing guidance. External hyperlinks are provided as a convenience to users but are out of Keele’s and Optum’s control and do not constitute an endorsement by Optum or Keele.

Published 11/02/25

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