The video version of this podcast can be found here:

·      https://youtu.be/kYcJ3Ym3C0A

This episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by NICE.

My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I go through new and updated recommendations published in July 2024 by the National Institute for Health and Care Excellence (NICE), focusing on those that are relevant to Primary Care only.

There were no updated guidelines or quality standards but, apart from some radiotherapy treatments, there were five technology appraisals, none of which were really relevant to Primary care. However, I give them a very quick overview

I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement.  

There is a podcast version of this and other videos that you can access here:

Primary Care guidelines podcast:

·      Redcircle: https://redcircle.com/shows/primary-care-guidelines

·      Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK

·      Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148

There is a YouTube version of this and other videos that you can access here: 

The Practical GP YouTube Channel: 

https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk

The Full NICE News bulletin for July 2024 can be found here:

·      https://www.nice.org.uk/guidance/published?from=2024-07-01&to=2024-07-31&ndt=Guidance&ndt=Quality+standard

The links to the current consultations can be found here:

Lebrikizumab for treating moderate to severe atopic dermatitis in people 12 years and over:

·      https://www.nice.org.uk/guidance/ta986/chapter/1-Recommendations

Tenecteplase for treating acute ischaemic stroke:

·      https://www.nice.org.uk/guidance/ta990/chapter/1-Recommendations

Ivacaftor–tezacaftor–elexacaftor, tezacaftor–ivacaftor and lumacaftor–ivacaftor for treating cystic fibrosis:

·      https://www.nice.org.uk/guidance/ta988/chapter/1-Recommendations

Etranacogene dezaparvovec for treating moderately severe or severe haemophilia B:

·      https://www.nice.org.uk/guidance/ta989/chapter/1-Recommendation

Trastuzumab deruxtecan for treating HER2-low metastatic or unresectable breast cancer after chemotherapy:

·      https://www.nice.org.uk/guidance/ta992/chapter/1-Recommendations

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Transcript

If you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description.

Hello and welcome, I am Fernando, a GP in the UK. Today, we are looking at the NICE updates published in July 2024. This month we have not had any new guidelines or quality standards but we have had a few new technology appraisals, that is, when NICE reviews new treatments to decide whether they should be recommended on the NHS. Apart from some radiotherapy recommendations, there were 5 other new treatments. Although none of them were really relevant to Primary care, I will give you a very quick overview so that we understand where new therapies are coming from and so that we have some knowledge if we come across them.

But do not worry, it is a real summary, and today will be a very brief episode. 

So, let’s jump into it.

The first area refers to the treatment of moderate to severe atopic dermatitis or eczema.

We know that standard treatment includes the topical use of emollients and steroids. If these treatments are not effective, systemic immunosuppressant treatments such as ciclosporin and methotrexate can be added. If there is an inadequate response or they are unsuitable, other agents such as a Janus kinase (JAK) inhibitor or a biological medicine (such as dupilumab or tralokinumab) can be used.

NICE has evaluated a new biological medicine alternative, lebrikizumab and indirect comparisons with Janus Kinase inhibitors and other biological treatments suggest that it is equally effective at an acceptable cost.

The biological treatments lebrikizumab, dupilumab, and tralokinumab are monoclonal antibodies that inhibit interleukin processes, thus reducing inflammation and modulating the immune response in conditions such as eczema and asthma. They are administered via subcutaneous injection and they can now all be used as  treatment options.

The next area covers the treatment of acute ischaemic stroke.

We know that once an intracranial haemorrhage has been ruled out, thrombolytic treatment can be started within 4.5 hours of the onset of stroke symptoms. The current standard thrombolytic treatment for this is alteplase.

Tenecteplase is an alternative to alteplase.  Tenecteplase, just like alteplase, turns plasminogen into plasmin, an enzyme that digests fibrin and acts like a pair of scissors to cut up the fibrin mesh in the clot, leading to clot dissolution and restoration of blood flow.

The evidence shows that tenecteplase is at least as effective as alteplase and a cost comparison suggests that it is less expensive, so it is also recommended.

The next area covers the treatment of cystic fibrosis, which we know affects the lungs, digestive system, and liver, and which reduces life expectancy and quality of life. Usual treatment is very physically demanding and time consuming for patients and their carers.

There are a number of tongue-twisting treatments namely ivacaftor, tezacaftor, elexacaftor, and lumacaftor, which work by improving the transport of chloride across cell membranes which in turn helps to hydrate and thin the mucus, particularly the lungs. They have been shown to improve lung function, growth and weight gain and reduce the number of lung infections.

They come as tablets or sachets and although expensive, NICE considers them to be cost effective, so, they are recommended.

The next area covers a gene therapy for Haemophilia B, etranacogene dezaparvovec, which reduces the number of bleeding episodes a person has each year. However, there is not enough evidence on how well it works in the long term so it is unclear as to whether it is cost effective. It is therefore not recommended for routine use in the NHS, but it can be used with managed access in order to try and collect more data.

The final area refers to the treatment of certain breast cancers with a combination drug, trastuzumab deruxtecan, which works by combining a monoclonal antibody targeting HER2-positive cancer cells with a potent chemotherapy drug, delivering the chemotherapy directly to the cancer cells. However, the cost-effectiveness estimates are unacceptably high, so, it is not recommended.

So that is it, very brief review of the new treatment updates.

We have come to the end of this episode. Remember that this is not medical advice and it is only my summary and my interpretation of the guidelines. You must always use your clinical judgement.

Thank you for listening and goodbye.