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Adult and Paediatric Anti-TNF policies for Severe Refractory Uveitis not approved for NHS England specialised commissioning

17 July 2015

The Royal College of Ophthalmology (RCOphth) and the Clinical Reference Group for specialised ophthalmology services (CRG) regret having to report that the Adult and Paediatric Anti -TNF policies for Severe Refractory Uveitis have not been approved for specialised commissioning. Following this announcement we have met with NHS England to stress how detrimental this decision will be to patients. Although we could not reverse the decision, it has been agreed that we will set up working groups to resubmit clinical evidence from the VISUAL and SYCAMORE randomised control trials.

If this evidence is accepted then revised policies could then be approved in this financial year (2015-16). However, the impact of the current policies not being approved is that no further patients can be started on Infliximab and Adalimimab. Those patients already on treatment can have their treatment continued. This only applies to patients in England. Patients in Scotland will continue to be able to have treatment and patients in Wales can apply for exceptional funding.

The Individual Funding Request (IFR) route is still available for patients who are significantly different from other patients with Severe Refractory Uveitis, and therefore fall outside the group of patients on which NHS England has already made their commissioning decision. An example of this would be a patient who has a major non-uveitic co-morbidity. Blinding disease alone will not make a patient eligible for an IFR.

It is important to highlight that NHS England’s commissioning decision only applies to anti-TNF treatments for Severe Refractory Uveitis. It does not apply to Ozurdex or other biologics such as Tocilizimab, Abatacept, Anakinra and Rituximab for the treatment of uveitis, and it also does not apply to applications for anti-TNF treatments in non-uveitic ophthalmic inflammatory diseases such as scleritis. For all these other treatments and indications the usual IFR and clinically critically urgent (CCU) processes remain open. We have asked NHS England to send a statement to the Local Area Team Commissioners to clarify this point.

RCOphth and CRG would encourage clinicians to write in to provide information on:

  1. When IFRs are declined for any intervention in a patient with uveitis or scleritis, and the stated reason for not funding
  2. Where clinicians feel that patients have come to harm and lost vision either because an IFR has been declined or as a result of the policy decision not to fund anti-TNF treatments

Please write to Bernie Chang, Chair – Professionals Standard Committee at the College at

From a CRG perspective we will continue to work to get the policies approved and would welcome support from colleagues and patients. For further information you can also contact

Alison Davis (CRG Chair)
Carrie MacEwen, President RCOphth

Adult and Paediatric Anti -TNF policies for Severe Refractory Uveitis 170715