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The Royal College of Ophthalmologists is delighted at landmark ruling in favour of the use of Avastin for wet AMD

21 September 2018

The Royal College of Ophthalmologists (RCOphth) welcomes the High Court decision that has found in favour for the use of bevacizumab (Avastin) in the treatment of wet age related macular degeneration (wet AMD).  Wet AMD is the biggest cause of vision loss in the UK and the hospital eye service is dealing with over 40,000 new diagnoses of wet AMD annually. It has been estimated that an adoption of Avastin, as part of a choice of drugs routinely prescribed for treatment, would release around £500million1 per year back to the NHS.  Read the full ruling outcome.

The ruling is vindication for The Royal College of Ophthalmologists, who have campaigned since 2012 for the use of Avastin in treatment for wet AMD.

Professor Andrew Lotery, RCOphth Scientific Chair says, ‘This is a great day for the NHS and patients.  The ruling is extremely welcome as the Royal College has long petitioned on the use of Avastin as an effective treatment for wet AMD.  Our members, ophthalmologists overseeing the treatment of patients with eye disease, can now feel assured that they can offer the best treatment for their patient’s individual needs.  We expect that the release of funds in the use of Avastin will be secured to improve patient care within the hospital eye service.’

The use of Avastin to treat wet AMD may have an impact on capacity within the hospital eye service, as more injections per planned treatment for patients may be needed. It is critical that trusts work with their clinicians and commissioners to ensure that any further increase in demand on the hospital eye service (predicted to increase by 50% over the next 20 years2) can be strategically planned to continue to deliver efficient and high-quality care for patients.

Whilst the ruling will be welcomed by all ophthalmologists in all four home nations, the hospital eye service remains seriously under-resourced in staff, equipment and infrastructure to deliver a safe and effective service, including the treatment of wet AMD. These issues have been raised in the recent All Party Parliamentary Group (APPG) report3 on Eye Health and Visual Impairment presented in Parliament on 6 June.

Mr Mike Burdon, RCOphth President says, ‘It is important that the regulatory bodies such as the GMC and the MHRA now reflect on the best ophthalmic practice in the light of this ruling and the previous supporting guidance from NICE. Licensing laws are designed to protect patients from poorly regulated and unproven drugs.  As recently as January, NICE guidance concluded that there was ‘no clinically significant differences in effectiveness and safety’ between Avastin and the current licenced drugs.’

The use of Avastin as an effective treatment and with positive cost benefits was supported by the National Institute for Health and Care Excellence (NICE)4 guidance published in January 2018.

The Royal College of Ophthalmologists is immensely grateful for everyone involved in bringing this case to the attention of the High Court. We applaud Mrs Justice Whipple for her comprehensive and well-argued judgement. She demonstrated in her ruling complete understanding of the medical issues, the roles and relationships of the relevant professional bodies and also addressed the issues raised by Bayer and Novartis Pharmaceuticals in the context of the law.

We hope to continue to work with the Department of Health, Trusts, the NHS, regulatory bodies and commissioners to secure the most effective and efficient clinical pathways for patients with eye disease to preserve and save sight.

 

Notes to Editors

In January 2018, together with the NHS Clinical Commissioners (NHSCC), we supported the decision by 12 care clinical commissioning groups (CCGs) in northern England to adopt a policy to allow patients a choice of treatment from the current three drugs available; Aflibercept (Eylea), ranibizumab (Lucentis) and the unlicensed Avastin to treat wet AMD.

  1. https://www.nature.com/articles/eye2016154 Shalaby et al performed a freedom of information request to all UK NHS ophthalmological units for the number of ranibizumab, aflibercept, and bevacizumab injections prescribed during January 2015. These results indicate the anti-VEGF injection cost to the NHS. They found that the vast majority of intravitreal injections (97%) were with the more expensive drugs ranibizumab and aflibercept. If all injections used divided bevacizumab, the estimated cost would be £607,749 (£729,500 incl. VAT) saving the NHS £449,196,354 (£539,035,492 incl. VAT) per year. This analysis does not include the confidential discount to the NHS, but it is likely that even if this could be taken into account the savings to the NHS would be multi-millions if it switched to bevacizumab from ranibizumab and aflibercept for treatment of wet AMD.
  2. https://www.rcophth.ac.uk/wp-content/uploads/2015/10/RCOphth-The-Way-Forward-Executive-Summary-300117.pdf
  3. All Party Parliamentary Group (APPG) on Eye Health and Visual Impairment outlines solutions to the current capacity issues in eye care services in England https://www.rcophth.ac.uk/2018/06/rcophth-endorses-the-appg-eye-health-report-see-the-light/
  4. NICE Guidance, Age related degeneration https://www.nice.org.uk/guidance/NG82

 

Further reading

IVAN study: Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med 2011;364:1897-908. https://www.ncbi.nlm.nih.gov/pubmed/21526923

Chakravarthy U, Harding SP, Rogers CA, Downes SM, Lotery AJ, Culliford LA, et al. Alternative treatments to inhibit VEGF in age-related choroidal neovascularisation: 2-year findings of the IVAN randomised controlled trial. Lancet 2013;382:1258-67. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61501-9/abstract

GMC: https://www.gmc-uk.org/news/media-centre/media-centre-archive/gmc-responds-to-new-nice-guidance

Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 2006;355:1419-31. https://www.ncbi.nlm.nih.gov/pubmed/17021318

http://www.bmj.com/content/349/bmj.g6887

The editorial ‘What is stopping the NHS from using bevacizumab for macular degeneration and other retinal disorders?’ is co-authored by Professor Caroline MacEwen, President RCOphth and Professor Andrew Lotery, RCOphth consultant member.