People affected by wet age-related macular degeneration (AMD) are facing an unacceptable postcode lottery for Eylea treatment.
Tony Rucinski, Chief Executive of the Macular Society, is calling for all areas of the NHS to make Eylea available for AMD patients who do not respond well to Lucentis. The move comes after a number of members reported that they have been refused Eylea even though their eye doctors recommended it.
Eylea was approved by the National Institute for Health and Care Excellence (NICE) in 2013 as a cost effective drug for wet AMD. However, some clinical commissioning groups (CCGs) have refused to allow its use for patients who have already had Lucentis as the NICE authorisation does not specifically say it should be used as a 'second line' treatment.
The CCGs are ignoring NICE clarification which makes clear that it is not specifying either first or second line treatment. NICE says “It is important to note that both ranibizumab and aflibercept are recommended ‘as options’, so the clinician will decide which of the drugs is most appropriate for each patient.
“This is no different from any disease area where more than one technology is approved by NICE ’as an option’. When NICE recommends a treatment ‘as an option’, the NHS must make sure it is available, normally within three months of the guidance being issued. This means that, if a patient has wet age related macular degeneration and the doctor responsible for their care thinks that aflibercept solution for injection is the right treatment, it should be available for use, in line with NICE’s recommendations.”
Advice from the Royal College of Ophthalmologists says "The College urges commissioners to adopt commissioning policies which are in the patient's best interests. This should allow the use of any of the NICE approved treatments for wet AMD both for initial treatment and subsequent management. This should include the option of switching anti-VEGF agents if clinically indicated."
Tony Rucinski says "The CCGs who refused to give patients Eylea are misreading NICE guidance. This is very serious as it puts people's sight at risk. As NICE guidance is regarded as legally binding on the NHS it may also be illegal.
"Some patients do not respond well to Lucentis and, where an ophthalmologist recommends it, Eylea should be offered in case it works better. Eylea has a similar mode of action to Lucentis but has some slightly different characteristics which mean it may work where Lucentis doesn't. The reverse is also true and it is clear that NICE's intention is that either drug can be used as first or second line care."