Media release: SMC decisions June 2025

The Scottish Medicines Consortium (SMC), which advises on newly licensed medicines for use by NHSScotland, has today (Monday, June 9) published advice on four medicines.

Cladribine (Mavenclad®) was accepted for the treatment of relapsing-remitting multiple sclerosis in adults who have signs of active disease either through clinical signs or evidence of inflammation on scans.

Selpercatinib (Retsevmo®) was accepted for the treatment of patients, 12 years and older, with a rare type of medullary thyroid cancer that is advanced and caused by mutations in a gene called RET.

Ruxolitinib (Jakavi®) was accepted to treat patients, aged 12 and over, with acute graft versus host disease where corticosteroids have not been effective. Acute graft versus host disease happens when donor cells attack the body shortly after a transplant.

Durvalumab (Imfinzi®) was not recommended when used together with tremelimumab as a first-line treatment for adults with hepatocellular carcinoma, the most common type of liver cancer when it is advanced or cannot be removed by surgery.

Notes to editor

1. The Scottish Medicines Consortium (SMC) is the national source of advice on the clinical and cost-effectiveness of all new medicines for NHSScotland. Our aim is to ensure that people in Scotland have timely access to beneficial new medicines.
2. We are part of Healthcare Improvement Scotland. Our committee is made up of clinicians, pharmacists, NHS board representatives, the pharmaceutical industry and the public. Most of the clinicians have a direct role in patient care, while our three volunteer public partners ensure the views of the Scottish public are taken into account during decision making. This wide mixture of backgrounds ensures decisions are made from a broad perspective.
3. Members of the SMC Committee make their decisions based on a broad range of evidence in order to help health professionals deliver the best possible care within the finite resources available. They consider detailed evidence presented by pharmaceutical companies, patient groups and clinicians in order to decide which medicines provide value for money for NHSScotland.
4. When we talk about value for money or cost effectiveness, this does not just mean how much a medicine costs to buy, but the wider costs and benefits associated with it being regularly used to treat those with a particular condition. The NHS does not have unlimited resources and if we accept a medicine where the benefits are not clear it may mean other patients lose out.
5. When considering a new medicine we look at:

• how well the medicine works
• which patients with the particular condition would benefit from it
• whether it is as good as or better than the medicines already used to treat the particular condition, and
• whether it is good value for money.

For more information on how we make our decisions, go to the SMC website, https://www.scottishmedicines.org.uk/how-we-decide/

1. Changes to the way we assess medicines for end of life and rare conditions (https://www.scottishmedicines.org.uk/how-we-decide/pace/) have allowed our committee additional flexibility in decision making. These changes include the option of a Patient and Clinician Engagement (PACE) meeting which gives patient groups and clinicians the opportunity to provide additional evidence to the committee.
2. A new approach to the assessment of medicines which treat extremely rare conditions has been introduced (https://www.scottishmedicines.org.uk/how-we-decide/ultra-orphan-medicines-for-extremely-rare-conditions/) in line with the Scottish Government announcement in June 2018 on a new pathway (https://news.gov.scot/news/treatments-for-rare-conditions)
3. SMC can make the following decisions on a medicine:

• accepted
• accepted with a restriction(s) (for example, the medicine can only be accepted in a particular group of patients with the condition. This typically occurs because the company has requested this explicitly in the submission)
• accepted on an interim basis, or
• not recommended

SMC can accept some medicines on an interim basis subject to ongoing evaluation and reassessment. You can find out more about this on our website https://www.scottishmedicines.org.uk/how-we-decide/interim-acceptance-decision-option/

SMC may be unable to accept a medicine for use in Scotland if the committee is not satisfied that the benefits of the medicine offer value for money for patients and the NHS or where there is a high degree of uncertainty about the clinical benefits of the medicine. You can find out more about the reasons we may not recommend medicines on our website: https://www.scottishmedicines.org.uk/how-we-decide/

For further information on ILAP, please visit the MHRA website https://www.gov.uk/guidance/innovative-licensing-and-access-pathway

For medicines that have not been recommended, SMC welcomes a resubmission from the company at any time with new clinical and/or economic evidence.

When a medicine has not been recommended by SMC, all NHS boards have procedures in place to consider individual requests when a doctor feels the medicine would be right for a particular patient.

For further information and to view the complete advice for the medicines detailed above, visit our website at: www.scottishmedicines.org.uk.