The Specialised Endocrinology Clinical Reference Group (CRG) is pleased that three of the ten drugs approved in the latest round by NHS England are endocrine-related, namely:

• pegvisomant, a third-line treatment in acromegaly
• pasireotide, for the treatment of refractory Cushing’s
• tolvaptan, used to treat hyponatraemia in cancer patients with SIADH (syndrome of inappropriate anti-diuretic hormone secretion) who are awaiting chemotherapy.

We should publically thank Simon Aylwin (London), Dan Flanagan (Plymouth) and Miles Levy (Leicester), who developed the pegvisomant, pasireotide and tolvaptan applications respectively. You can find out more on the NHS England website. This development means that endocrinologists can use these drugs according to fixed criteria.

For pegvisomant, the criteria include: previous surgery and radiotherapy (usually), a lack of biochemical remission with somatostatin analogues, and a documented discussion by a recognised pituitary multidisciplinary team (MDT).

Blueteq technology (the platform for many cancer drugs) will be used. NHS England are developing an electronic pro forma with input from the CRG. The anticipated process will be that an online application will be made after the MDT meeting, and then the prescription will be sent to a home care team. The home care company will deliver the medicine to the patient’s address within 10 days. Nursing support to complement this service will be optional, and will include blood tests and disease monitoring. The home care company will invoice the hospital trust. The hospital trust will then cross-charge NHS England.

It is envisaged that details of these patients will be submitted to the acromegaly database.

The CRG is also starting work on parathyroid hormone for hypoparathyroidism.

John Wass

On behalf of the Society’s Clinical Committee

DASHBOARD UPDATE

Society members will recall there is now an endocrine dashboard, used by NHS England to try and ensure that there are reasonably efficient systems in place for the assessment of endocrine patients and the various processes involved. As a separate issue, for those endocrinologists involved with the dashboard, it’s very important that these are filled in by clinicians as far as possible.