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BNSSG Paediatric Joint Formulary

8.1 Immune system

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Last edited: 13-08-2025

First line drugs

Second line drugs

Specialist drugs

Secondary care drugs

8.1.1 Immune system disorders and transplantation

NHS England Clinical Commissioning Policy: Haematopoietic Stem Cell Transplantation (HSCT) (All Ages): Revised Reference: NHS England B04/P/a

Immunosuppressive therapy for renal transplantation in children and adolescents. NICE TA482

Immunostimulants

Leniolisib (TLS Red)

NHSE SSC 2801 Leniolisib for activated phosphoinositide 3-kinase delta syndrome in people 12 years and over

Antimetabolites

Azathioprine (oral & parenteral) (TLS Red)

Azacitidine (parenteral) (TLS Red)

Via NHS England for myelodysplastic syndromes

Calcineurin Inhibitors and Related Drugs

Ciclosporin (oral & parenteral) (TLS Red)

Prescribe by brand

Sirolimus (oral) (TLS Red)

Renal Consultant, haematology, BMT physician use only

Tacrolimus (oral & parenteral) (TLS Red)

Prescribe by brand
NICE TA482 Immunosuppressive therapy for kidney transplant in children and young people

Immunoglobulins

Antithymocyte globulin (ATG) (rabbit) (TLS Red)

Renal, Immunology, Haematology and BMT Consultant use only, as per Trust protocol

Antithymocyte globulin (ATG) (horse) (TLS Red)

NHS England funded

Monoclonal Antibodies (Anti-lymphocyte)

Alemtuzumab (parenteral) (TLS Red)

Pre-transplant immunosuppression and CLL according to NHS England guidance only
Treatment of relapsed or refractory chronic lymphocytic leukaemia
1st line treatment of chronic lymphocytic leukaemia in patients with 17p deletion
2nd line treatment of chronic lymphocytic leukaemia in patients with 17p deletion previously treated with chemotherapy but not alemtuzumab
1st line treatment of T-cell prolymphocytic leukaemia
2nd line treatment of T-cell prolymphocytic leukaemia

Basiliximab (parenteral) (TLS Red)

Basiliximab may only be prescribed in line with the Renal Unit protocol.
NICE TA482 Immunosuppressive therapy for kidney transplant in children and young people

Canakinumab (TLS Red)

For periodic fever syndromes as per NHSE Commissioning Policy

Tocilizumab (TLS Red)

NHSE SSC 2871 NHS England Clinical Commissioning Policy - Tocilizumab for Neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) refractory or intolerant to previous lines of therapy (Adults)

Protein Kinase Inhibitors

Ruxolitinib (TLS Red)

NICE TA1054 Ruxolitinib for treating acute graft versus host disease that responds inadequately to corticosteroids in people 12 years and over

Interleukin Inhibitors

Anakinra (TLS Red)

For Haemophagocytic Lymphohistiocytosis as per NHSE Commissioning Policy

Purine Synthesis Inhibitors

Mycophenolate mofetil (oral & parenteral) (TLS Red)

NICE TA482 Immunosuppressive therapy for kidney transplant in children and young people.
Also used for immunomodulation / immunosuppression (unlicensed) under the supervision of Specialists in:

Neurology - see Chapter 10

Rheumatology - see Chapter 10

Gastroenterology - see Chapter 1

Ophthalmology- see Chapter 11

Renal (non-transplant use)

Dermatology - see Chapter 13

Respiratory

IV and oral in BMT specialist use

Alternative to mycophenolate mofetil: