Eye injections to be available on NHS
Publication Date:04/04/2008
A new treatment for macular degeneration, a common cause of poor vision, looks set to become widely available on the NHS, according to guidelines for doctors. The treatment is called Lucentis and it is given by injection into the eye. Lucentis can reduce the chances of eyesight getting worse.
Previous draft guidelines, published for consultation last June, had advised that Lucentis should be restricted to about one fifth of people with the disease, who should have treatment in one eye only. Many people disagreed with this and the advice has now been changed.
What do we know already?
Age-related macular degeneration (AMD) is the most common cause of poor eyesight among older people. There are two main types: wet and dry. Wet AMD is the more serious type and gets worse faster.
In wet AMD, tiny new blood vessels form at the back of your eye. The blood vessels leak and damage part of the eye called the macula.
People start to notice a blurry patch in the centre of their vision. Over time, it gets darker and may spread. If you have wet AMD in one eye, you have about a 1 in 2 chance that it will start in the other eye as well. Some people with wet AMD go blind.
The new guidelines looked at two new treatments for wet AMD: Lucentis (also called ranibizumab) and another medicine, called Macugen (also called pegaptanib). They are both given as injections into the eye. One large study has shown that they both reduce the chance of eyesight getting worse, but Lucentis seems to work better.
Researchers looked at how many people's vision got much worse over a year, measured by losing more than 15 letters on an eye chart:
- Between 38 in 100 and 45 in 100 people who had a dummy treatment (a placebo) got much worse
- 30 in 100 people who had Macugen got much worse
- 5 in 100 people who had Lucentis got much worse.
We don't know if there are any long-term side effects with Lucentis. The studies only lasted two years. But injections into your eye can cause swelling, pain, redness and blurred vision. These problems usually go away after a short time. Some people in the study got a serious eye infection after having treatment. This happened to 1 in 100 people. Another 1 in 100 people got swelling inside the eye.
What does the new report say?
The report says Lucentis works well enough to use on the NHS, for up to 14 injections. It says it should be used for one or both eyes as needed. If the patient needs more than 14 injections, the manufacturer of the drug will have to pay for it. This deal means the treatment is now affordable enough to be provided on the NHS.
People are likely to need 8 injections in the first year, and 6 injections in the second year. The first three injections are given monthly, then after that whenever the doctor thinks they are needed. The patient will continue to be checked every month.
But the report says Macugen doesn't work well enough to use on the NHS. People who are already receiving treatment with it on the NHS can continue. But no-one else should start treatment.
Where does the study come from?
The new study is from the National Institute for Health and Clinical Excellence (NICE), the group that advises the government on what treatments should be available on the NHS.
What does this mean for me?
This report is important for anyone with wet AMD in England and Wales. You need to know what type of AMD you have. These treatments are only for wet AMD. Dry AMD is nine times as common as wet AMD. Most people with dry AMD don't lose their sight.
Although the report is not yet final, it's unlikely that the main recommendations will be changed. But until the final guidelines are published it's up to local healthcare organisations to decide whether these treatments should be used. NICE only makes decisions about healthcare in England and Wales. In Scotland, both these drugs are available on the NHS for anyone with wet AMD.
These injections are not the only treatments for AMD. Your doctor can tell you about the alternatives, and whether they are likely to be helpful for you.
What should I do now?
You can read the draft guidelines from NICE on their website, www.nice.org. You can also send your comments about the guidelines to NICE, using a form on the website, until 16 April. The final guidelines are expected to be published in June. Then it's up to the government to decide whether to accept the guidelines for use in the NHS.
If you have wet AMD and you would like to know more about these treatments, ask your doctor about their risks and benefits. Your doctor may also be able to tell you whether your local healthcare organisation has agreed to pay for these treatments, while NICE is making its final decision.
From:
National Institute for Health and Clinical Excellence. Macular degeneration (age-related) pegaptanib and ranibizumab: Final appraisal determination. April 2008. Available at www.nice.org.uk (accessed on 3 April 2008).
For more information about age-related macular degeneration and its treatment, see our information on AMD.
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