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GP leaders advise practices not to prescribe cholesterol lowering drug inclisiran

BMJ 2023; 382 doi: (Published 01 August 2023) Cite this as: BMJ 2023;382:p1757
  1. Gareth Iacobucci
  1. The BMJ

Local GP leaders across the south of England have told practices not to follow the NHS’s advice to prescribe the cholesterol lowering drug inclisiran because of concerns over funding and long term safety monitoring.

The pushback comes amid a drive by NHS England, which published funding guidance in April 2023,1 and local integrated care boards (ICBs) to make the drug available in primary care to help tackle cardiovascular disease.

The National Institute for Health and Care Excellence (NICE) approved inclisiran—made by Novartis and marketed as Leqvio—in 2021,23 hailing it as “a potential game changer in preventing thousands of people from dying prematurely from heart attacks and strokes.” Administered by injection, inclisiran uses RNA interference to boost the liver’s ability to remove low density lipoprotein cholesterol (LDL-C) from the blood.

However, the BMA, the Royal College of General Practitioners,45 and experts writing in The BMJ6 have raised concerns about inclisiran being initiated in primary care because of the lack of long term data on its cardiovascular outcomes and safety, as well as a lack of resources to administer it and monitor patients.

The BMJ has learnt that a host of local medical committees (LMCs) in southern England have advised GPs not to initiate the treatment and instead to refer patients to secondary care until additional funding arrangements are in place. This includes Kent LMC, which said in a statement sent to practices, “Practices do not have capacity or resources to do this additional work.” Wessex LMCs,7 Somerset LMC, Avon LMC, Devon LMC, Kernow LMC, and Cambridgeshire LMC have also recommended that practices do not prescribe and administer inclisiran in primary care without the provision of a locally enhanced service.

Kent LMC’s response came after NHS …

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