Repurposing medicines in the NHS in England

Did you know?

Repurposed medicines have been used as effective treatments for COVID-19. An example of this is tocilizumab, originally an arthritis drug, that has been shown to support recovery from COVID-19 pneumonia in hospitalised patients and cut the relative risk of death by 14%. It is typically used in addition to dexamethasone, another repurposed drug with significant mortality (lifesaving) benefits in the treatment of COVID-19.

In 2017 the Association of Medical Research Charities (AMRC) released the report, Facilitating adoption of off-patent, repurposed medicines into NHS clinical practice. The report focused on opportunities for the repurposing of medicines, through further research and by facilitating the formal licensing of medicines that were already commonly prescribed off-label. It was identified in the report that whilst it was likely that there were high levels of off-label prescribing happening within the NHS, more consideration was required to address the potential to repurpose medicines more systematically.

NHS England and Improvement (NHSEI), in partnership with other organisations, subsequently prepared a report on how those national agencies would collectively address and action key repurposing opportunities.

The Repurposing Medicines Programme has since been established to identify and pursue opportunities to strengthen the evidence base, licensing, supply, cost-effectiveness and equitable adoption of currently un-licensed or off-label medicines, where there is benefit to the NHS and patients.

Working in collaboration with member organisations in managing the rapid consideration and adoption of repurposed medicines as treatments for COVID-19 has provided the opportunity to test, refine and streamline our approach, as well as identifying further promising repurposing opportunities.

Repurposing Medicines Programme objectives

The programme aims to:

  • Focus on identifying and developing opportunities to repurpose promising medicines to improve outcomes, patient experience and value for money
  • Facilitate and encourage the licensing of medicines that are commonly prescribed off-label to support clinical decision making and improve equity of access
  • Support and advance innovative and new research into medicines that might be repurposed and adopted into the NHS.

What is drug repurposing?

Drug Repurposing identifies new uses for approved or investigational drugs that are outside of the scope of the originally intended use for the medicine. This typically involves taking an existing medicine that already has a marketing authorisation or licence for human use for a particular condition, and then use it to treat another condition. Alternatively, a repurposed medicine may be used in a different dose, or form, than its original licence (for example an inhaled product, rather than a tablet).

What is ‘off-label’ prescribing?

The use of medicines outside of the scope of their licence, also known as ‘off-label’ prescribing, is part of normal clinical practice where there is no suitable licensed product available for given condition or indication, and where the clinician is satisfied that there is sufficient evidence of the medicine’s effectiveness and safety. Many new and valuable uses of medicines have been discovered through this method. One well-known example would be Aspirin – initially a pain medication that is now used in the management of heart conditions.

Identifying repurposing opportunities

The Repurposing Medicines Programme is a collaboration that builds on early work with charities and clinicians. Initial pilots for repurposing medicines have been identified, in partnership with charities and the British Generic Manufacturers Association.  One of the programme’s first tasks is to develop a simple route for clinicians and charities to put forward candidate repurposing opportunities for consideration.

Progressing repurposing opportunities

In addition to identifying opportunities to repurpose a medicine, work must also be done to make sure that once a beneficial off-label medicine has been identified, the essential steps can be taken quickly to ensure that there are no unnecessary delays to patient care. To do this, a small central team has been established to support the programme, overseen by a multi-agency steering group, with a view to bringing new indications either to the point of licensing, or to equitable access through the use of a number of other approaches, as soon as possible whilst ensuring safety.

It is also important for the NHS to work with both the pharmaceutical industry and generic manufacturers to support repurposing. To facilitate this, NHSEI holds regular discussions with stakeholders to ensure that this innovative work is carried out in collaboration and partnership.

Contact

Please contact england.repurposing@nhs.net for any general enquiries.