Latest SMC recommendations released

The SMC has accepted products licensed for type II diabetes and HIV in its latest review of new treatments.

First licensed buccal midazolam product (Buccolam) among latest SMC recommendations
First licensed buccal midazolam product (Buccolam) among latest SMC recommendations


The Scottish Medicines Consortium (SMC) has accepted the following drugs for use in NHS Scotland:

  • erlotinib (Tarceva) for first-line treatment of non-small cell lung cancer with epidermal growth factor receptor activating mutations.
  • linagliptin (Trajenta) for restricted use in type II diabetes in combination with metformin, when glycaemic control with metformin and diet and exercise alone is inadequate and addition of a sulfonylurea is inappropriate.
  • oromucosal midazolam solution (Buccolam) for the treatment of prolonged, acute, convulsive seizures in children aged 3 months to <18 years.
  • prolonged-release exenatide (Bydureon) is accepted for third-line treatment of type II diabetes in combination with oral hypoglycaemics, including metformin, a sulfonylurea and/or a glitazone, in adults who have not achieved adequate glycaemic control on maximally tolerated doses.
  • rilpivirine as a single component tablet (Edurant) to be used in combination with other antiretrovirals, and as a fixed-dose combination tablet also containing emtricitabine and tenofovir disoproxil (Eviplera), both for the treatment of HIV-1 infection in treatment-naive patients with plasma HIV-1 RNA ≤100,000 copies/ml.
  • rivaroxaban (Xarelto) for the treatment of deep vein thrombosis (DVT) and prevention of recurrent DVT or pulmonary embolism following acute DVT and for restricted use in prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF) with one or more risk factor for stroke. For prevention of stroke in AF, it is restricted to use in patients with poor INR control despite compliance with a coumarin anticoagulant or if coumarins not tolerated or inappropriate.
  • tocilizumab (RoActemra) for active systemic juvenile idiopathic arthritis in children >2 years of age who have responded inadequately to NSAIDs and systemic corticosteroids.

Not recommended

The SMC does not recommend the use of entecavir (Baraclude) for chronic hepatitis B in adults with decompensated liver disease although it is recommended for patients with compensated liver disease. It also rejected ranolazine (Ranexa) as add-on therapy in stable angina for patients inadequately controlled by or intolerant of first-line therapy, and inhaled aztreonam lysine (Cayston) for chronic pulmonary infections due to P. aeruginosa in adults with cystic fibrosis.

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