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NHS Scotland's March 2019 Funding Decisions

The Scottish Medicines Consortium (SMC) has this month approved drugs for acute myeloid leukaemia and cytomegalovirus but a drug for diffuse B cell lymphoma was rejected.

Acute Myeloid Leukaemia (AML)

Liposomal daunorubicin/cytarabine (Vyxeos, Jazz Pharmaceuticals UK) was accepted by the NHS in Scotland for the treatment of adults with a high-risk type of acute myeloid leukaemia (AML).

The SMC said the drug can improve remission rates and overall survival, and offers an increased chance of potentially curative stem cell transplantation.

It involved fewer doses than current treatment.

The decision was made after patient group representations highlighted the toxic effects of current standard chemotherapy and the necessary inpatient hospital stays.

Vyxeos contains daunorubicin and cytarabine in liposome fat droplets, which help to keep the medicine in a patient's body for longer and lets it build-up in bone marrow.

SMC Chair Dr Alan MacDonald said in a news release: "Patients with high-risk acute myeloid leukaemia have a very poor prognosis and high unmet need. Liposomal daunorubicin/cytarabine offers an improvement in overall survival and may lead to a potentially curative stem cell transplant for some patients."

Cytomegalovirus (CMV)

The SMC's Patient and Clinician Engagement (PACE) process for end of life care and rare conditions influenced the positive decision for letermovir (Prevymis, Merck Sharp & Dohme Limited) to help prevent illness due to cytomegalovirus (CMV) infection after stem cell transplantation.

The antiviral medicine helps reduce the risk of this infectious transplant complication.

Dr MacDonald said: "For patients who have undergone a stem cell transplant, letermovir can aid their recovery by reducing the risk of CMV infection."

Diffuse B Cell Lymphoma

The PACE process was also used for tisagenlecleucel (Kymriah, Novartis) for adult patients with diffuse B cell lymphoma who have relapsed or not responded after two previous lines of treatment. 

However, the SMC did not approve its use because of uncertainties in the evidence given by the manufacturer.

Dr MacDonald said: "Although the PACE process gives our committee members additional flexibility in their decision making, they were unable to accept tisagenlecleucel for patients with lymphoma as the company’s evidence around its long-term benefits was not clear."