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NHS Clinical Commissioners co-ordinate support from CCGs to review use of Avastin to treat wet AMD

25 February 2015

College Statement

In response to the public letters sent by the NHS Clinical Commissioners to Secretary of State for Health, cc. Chair of NICE; Simon Stevens at NHS England; and the Chair of the GMC and signed by the Clinical Chair / Lead Clinician of 120 CCGs regarding the use of Avastin to treat wet AMD.

The Royal College of Ophthalmologists repeats its call for UK regulatory bodies to appraise the use of bevacizumab (Avastin) for wet age related macular degeneration, potentially saving NHS England over £100million a year.

Age related macular degeneration (AMD) is the commonest cause of blindness among elderly people in the developed world. The ageing population in the UK and associated eye conditions and diseases is adding to the capacity issues facing many hospital eye care services, impacting resources and funding.

Ranibizumab (Lucentis), the first drug used to treat this condition was licensed for AMD treatment and approved by NICE in 2008. Two major studies, the CATT2 and the IVAN3 studies, found that an alternative drug, bevacizumab (Avastin), which is licensed for the treatment of some cancers, but does not have a licence for use in AMD, was as effective as the licensed ranibizumab. Several other studies and a recent Cochrane review have supported the effectiveness and safety of the two similar drugs.

The IVAN study also identified that using bevacizumab could save NHS England £102million a year, money which could be used to relieve the capacity issues in hospital eye clinics which can result in avoidable sight loss for patients.

Drugs are appraised for cost and clinical effectiveness by the National Institute for Health and Care Excellence (NICE) after being licensed by the Medicines and Healthcare products Regulatory Agency (MHRA). Drugs are normally submitted for approval by the pharmaceutical company that owns them. Roche, which owns bevacizumab, has not applied for a licence for its use to treat AMD.

It is vital that clinicians are not pressurised into prescribing Avastin if they feel an alternative licensed treatment would be more beneficial to their patient. Commissioning policies must enable clinicians to access NICE approved treatments as mode of action, frequency of delivery and patient response vary with different drugs. GMC guidance indicates that an unlicensed drug should not be used when a licensed drug is available and this means that ophthalmologists cannot use Avastin in preference to Lucentis without breaching this guidance.

Whist the College welcomes more debate around a review of the use of Avastin to effectively treat AMD, our primary responsibilities are to ensure patients receive the best possible treatments for their eye conditions and for ophthalmologists to be freely able to make the right choice of medical treatments for their patients.