Bee and wasp venom hyposentisation agents
- a previous severe systemic reaction or
- a moderate systemic reaction plus one of the following: raised baseline serum tryptase; a high risk of future stings; or anxiety about future stings
Prolonged-release exenatide (Bydureon) is recommended as part of both dual and triple therapy regimens for type II diabetes when adequate glycaemic control is not achieved from other oral hypoglycaemic agents. It is recommended as dual therapy in combination with metformin or a sulfonylurea, or as triple therapy in combination with metformin plus a sulfonylurea or a glitazone.
Dual therapy should only be continued if there is a beneficial metabolic response, defined as a ≥1% point reduction in HbA1C at 6 months. Triple therapy should only be continued if a ≥1% point reduction in HbA1C is observed and the patient has reduced their initial body weight by at least 3% at 6 months.
Tocilizumab for rheumatoid arthritis
NICE has clarified the recommendations for the use of tocilizumab (RoActemra) in rheumatoid arthritis. The anti-IL-6 receptor antibody can be used in cases that have responded inadequately to DMARDs, another TNF inhibitor and/or rituximab, only if the manufacturer provides tocilizumab with the discount agreed as part of the patient access scheme.