What's New in Guidelines

XVIVO Perfusion System enables ex-situ assessment of marginal donor lungs before transplantation, allowing objective evaluation of organ viability and function to improve transplant outcomes and reduce futile procedures. Machine perfusion reconditioning can potentially expand…

Trastuzumab deruxtecan is recommended as an option for HER2-positive unresectable or metastatic breast cancer only after 1 or more prior lines of anti-HER2 treatment—use in treatment-naïve patients is not supported by this guidance Consider…

Insulin efsitora alfa is recommended as a treatment option for type 2 diabetes and should be considered within NICE guidance criteria—confirm patient eligibility and glycaemic control targets before initiation Assess baseline renal function and…

Nirogacestat is recommended as an option for treating desmoid tumours in adults when surgery is not suitable or has failed, enabling consideration of this gamma-secretase inhibitor as a disease-modifying treatment in your practice Confirm…

Use digital platforms (apps, websites, videos) as adjuncts to standard pre-operative education for hip/knee replacement patients to improve engagement and knowledge retention, particularly for younger or digitally-confident patients, while maintaining face-to-face consultations for comprehensive…

Trastuzumab deruxtecan is recommended by NICE as a treatment option for HER2-low metastatic or unresectable breast cancer, making it suitable for patients who progress after prior chemotherapy and would otherwise have limited targeted options.…

AI-assisted EEG interpretation software can support clinicians in identifying abnormalities suggestive of epilepsy, but should complement rather than replace expert clinical review—use as a triage or second-opinion tool to improve diagnostic accuracy and efficiency…

Daratumumab with bortezomib, lenalidomide and dexamethasone is recommended as an option for untreated multiple myeloma in patients suitable for stem cell transplantation—consider this as a first-line induction regimen to improve response rates before transplant.…

Isatuximab combined with pomalidomide and dexamethasone is recommended by NICE for relapsed and refractory multiple myeloma patients who have received at least one prior therapy, offering a treatment option with demonstrated efficacy for this…

Ibrutinib combined with R-CHOP is recommended for untreated mantle cell lymphoma patients who are fit enough to undergo stem cell transplantation, offering improved outcomes compared to R-CHOP alone Ensure patient fitness assessment for stem…

Consider recommending digital home monitoring devices (such as Amsler grid apps or automated retinal imaging tools) to patients with advanced dry AMD as an adjunct to standard care, as evidence suggests these may help…

Mirdametinib is indicated for symptomatic and inoperable plexiform neurofibromas in children aged 2-17 years with neurofibromatosis type 1 (NF1); confirm diagnosis and operability status before initiating treatment to ensure appropriate patient selection. Establish baseline…

Nemolizumab is recommended by NICE for adults with moderate to severe prurigo nodularis who have inadequate response to topical treatments or systemic corticosteroids, enabling earlier access to effective biologic therapy before exhausting conventional options…

Durvalumab combined with platinum-based chemotherapy is the recommended first-line treatment for untreated advanced or recurrent endometrial cancer, with olaparib addition considered based on individual patient factors and trial data. Assess patient eligibility carefully before…

Test for MSI-H/dMMR before treatment: All patients with advanced or recurrent endometrial cancer should undergo microsatellite instability or mismatch repair deficiency testing prior to dostarlimab consideration, as eligibility depends on confirmed MSI-H or dMMR…

Evaluation terminated: Brensocatib for non-CF bronchiectasis is no longer under NICE appraisal—do not initiate new treatment pathways for this indication pending alternative guidance from your local formulary or commissioning team. Age consideration: Any prior…

Evaluation terminated – Rilzabrutinib for immune thrombocytopenia (ITP) is no longer under NICE appraisal; refer to current NICE guidance or your local ITP treatment pathway for approved options Check current formularies – Do not…

This NICE evaluation was terminated, meaning lisocabtagene maraleucel is not currently recommended for routine NHS use in relapsed or refractory follicular lymphoma—do not commission or initiate treatment based on this technology appraisal. Patients with…

Consider ex-situ machine perfusion as an alternative to static cold storage for deceased donor livers, particularly for higher-risk grafts (extended criteria donors, prolonged cold ischaemia time) to potentially reduce primary non-function and early allograft…

Use acalabrutinib with venetoclax ± obinutuzumab as first-line treatment for untreated CLL – this combination is recommended by NICE and offers improved outcomes compared to standard chemotherapy, particularly in fit patients with del(17p) or…

First-line treatment option: Acalabrutinib combined with bendamustine and rituximab is recommended as a first-line treatment for untreated mantle cell lymphoma, offering an alternative to standard chemotherapy regimens. NICE-appraised intervention: This combination has undergone NICE…

Donidalorsen is recommended as a preventive treatment option for recurrent hereditary angioedema (HAE) attacks in patients aged 12 years and over – consider it when patients experience frequent symptomatic episodes despite current management, ensuring…

Finerenone is recommended as an option for chronic heart failure with preserved or mildly reduced ejection fraction (HFpEF/HFmrEF) and can be initiated in primary or secondary care following NICE criteria assessment Use finerenone alongside…

Refer boys with DMD to orthopaedic services early to prevent contractures and maintain mobility—early intervention with stretching, splinting, and positioning can delay loss of ambulation and reduce future surgical needs. Coordinate care between neuromuscular…

Patient selection: Consider aficamten for symptomatic obstructive hypertrophic cardiomyopathy patients who remain symptomatic despite optimised standard therapy (beta-blockers, non-dihydropyridine calcium channel blockers, or disopyramide), or who cannot tolerate these medications. Baseline assessment required: Obtain…

Use the FRAX tool or DXA scan results to stratify fracture risk in adults aged 50+ with risk factors (prior fracture, corticosteroid use, family history, low BMI, smoking, alcohol excess) rather than treating all…

Evaluation terminated – NICE discontinued appraisal of lutetium-177 vipivotide tetraxetan; this agent is not recommended for routine NHS use and should not be prescribed outside approved clinical trials or research programmes Patient selection criteria…

Netarsudil evaluation by NICE was terminated, indicating it is not recommended for routine use in NHS treatment pathways for open-angle glaucoma or ocular hypertension—continue using established first-line agents (prostaglandin analogues, beta-blockers, or carbonic anhydrase…

Deuruxolitinib is recommended as a treatment option for severe alopecia areata in adults—consider initiation in patients with extensive hair loss where conventional therapies have failed or are unsuitable Monitor patients on deuruxolitinib for infection…

Pembrolizumab combined with chemoradiotherapy is recommended for untreated locally advanced cervical cancer, improving survival outcomes compared to chemoradiotherapy alone—consider this combination as first-line treatment in eligible patients. Ensure baseline PD-L1 testing and assessment of…

Teplizumab is recommended for people aged 8 years and over with stage 2 type 1 diabetes to delay progression to stage 3; discuss with patients/families the realistic timescale for benefit and arrange specialist endocrinology…

First-line topical option: Glycopyrronium bromide cream is recommended as a first-line treatment for severe primary axillary hyperhidrosis in adults, offering an effective alternative to antiperspirants when standard treatments fail. Application and monitoring: Apply to…

Cemiplimab is recommended as a treatment option for patients with recurrent or metastatic cervical cancer only after progression on or following platinum-based chemotherapy—ensure prior chemotherapy failure is documented before considering this PD-L1 inhibitor. Assess…

Pirtobrutinib is recommended as a treatment option for relapsed or refractory chronic lymphocytic leukaemia (CLL) specifically in patients who have progressed on a prior BTK inhibitor, making it suitable for second-line BTK-directed therapy in…

Preoperative assessment: Systematically identify and optimise modifiable risk factors (cardiovascular, respiratory, renal function, anaemia, diabetes control) before elective surgery to reduce perioperative complications and length of stay. Venous thromboembolism (VTE) prophylaxis: Assess VTE risk…

Atogepant is recommended as a preventive treatment option for episodic migraine in adults; consider initiating in patients with ≥4 migraine days per month who have failed or are intolerant to other preventive agents Baseline…