NICE backtracks on wet AMD guidance

NICE has backtracked on draft guidance on wet age-related macular degeneration (AMD), which originally only advocated treatment of the second affected eye.

When the draft guideline was originally released in June, experts feared many AMD patients would be left without treatment options.

These guidelines stated that the anti-vascular endothelial growth factor drug ranibizumab (Lucentis) should only be used in patients when their second eye becomes affected. Another drug, pegaptanib (Macugen), was not recommended.

But today, NICE has announced updates to the draft guidance and recommends treating the first affected eye with ranibizumab. Under a ‘dose-capping’ scheme suggested by manufacturers, NICE recommends that the NHS should pay for a maximum of 14 injections of ranibizumab per eye for patients with wet AMD. This should result in stable vision for most patients and improved vision in around a quarter. Any further injections needed would be funded by the manufacturer.

Andrew Dillon, chief executive of NICE, said of responses to the original consultation: ‘Two key issues in particular were highlighted by those who responded: first, that allowing the first eye to deteriorate would cause anxiety and depression; and two, that treating only the second eye could mean losing the chance to preserve vision if it was affected by untreatable vision loss or didn’t respond to treatment.

‘NICE has taken these concerns on board and now recommends treating the first eye to come to clinical attention.’

Consultations on the amended draft guidelines on AMD will run until 14 January 2008.

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