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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 August 18; 335(7615): 319.
PMCID: PMC1949435

NICE delays decision on drugs for macular degeneration

The National Institute for Health and Clinical Excellence (NICE) has had to delay its final decision on two drugs for age related macular degeneration after mounting pressure from charities and healthcare professionals.

NICE, which advises health authorities in England and Wales on the treatments to use on the NHS, issued preliminary guidance in June on the use of ranibizumab (marketed as Lucentis) and pegaptanib (Macugen) for the treatment of the disease. Both drugs are already available in Scotland.

It argued that pegaptanib should not be used at all and that ranibizumab should be prescribed only to the one in five people with the neovascular or “wet” form of the disease and only where both eyes were affected and in the better seeing eye only.

Both drugs target vascular endothelial growth factor, high concentrations of which can prompt excess blood vessel formation and fluid leakage in the eye.

Around 26 000 people develop the wet form of age related macular degeneration every year in the United Kingdom, and 245 000 people are blind or visually impaired as a result.

NICE's conclusions sparked a wave of protest from patients and healthcare professionals that continued after the statutory consultation period closed, after a campaign spearheaded by the Royal National Institute for the Blind (RNIB).

The Royal College of Ophthalmologists and the Royal College of Nursing had both pressed for the drugs to be made available to NHS patients, and the Drug and Therapeutics Bulletin, published by the BMJ Publishing Group, called NICE's stance “unacceptable.”

The institute said at the time of its initial decision that both drugs were very expensive and that most people with age related macular degeneration sought help only once their second eye was affected.

But last week it decided to postpone its deliberations until the autumn while it reviews the figures for the projected costs to the NHS. In a statement it said that it would “be carrying out further economic modelling for this appraisal.”

Welcoming the move the Royal College of Ophthalmologists hoped that the new draft guidance would “take into account all the submissions made by consultees rather than just the costs involved in treatment.” It warned NHS trusts that any restrictive criteria imposed in the absence of guidance from NICE were “no longer acceptable.”

Some specialists have been prescribing a cheaper alternative, bevacizumab (Avastin), which is currently licensed for the treatment of bowel cancer.

The royal college said that it supported doctors doing all they could to treat “desperate patients,” but while preliminary data were “very encouraging” it could not sanction the drug's use until more information on its safety and efficacy became available.

A spokesperson for Roche, the manufacturer of bevacizumab, said the company had no plans to apply for a licence for it to be used in eye disease.

Articles from The BMJ are provided here courtesy of BMJ Group