Devon CCG backs down on Avastin AMD switch

Clinical commissioning group (CCG) has cancelled plans to switch to Avastin for AMD patients, despite potential NHS savings of more than £100m a year

16 Mar 2015 by Ryan O'Hare

The ongoing debate around the use of cancer drug Avastin for patients with age-related macular degeneration (AMD) took another twist last week, as a south of England clinical commissioning group (CCG) backed down over safety and regulatory concerns.

Northern, Eastern and Western (NEW) Devon had planned to introduce Avastin as a first line treatment for AMD. A spokesperson for NEW Devon CCG, told OT: “We decided against progressing with developing a local policy due to issues around the licensing of the drug and compatibility with General Medical Council (GMC) and National Institute for Health and Care Excellence (NICE) guidance.”

The drug, which is not currently licensed for use in AMD, can be used in an ‘off label’ capacity, however, there is no official guidance on its use in this capacity. Previous research has estimated that a switch to Avastin, which costs one tenth of first line recommended treatment Lucentis, could save the NHS more than £100m a year. A review from independent evidence-based review group, the Cochrane Collaboration, showed that Avastin has a comparable safety profile to Lucentis.

Last month, the heads of 121 CCGs in England signed a letter to chief of NHS England, Simon Stevens, asking for support in their case to the secretary of state for health, Jeremy Hunt, the GMC and the NICE. The letter called for Mr Stevens to support commissioners looking to use Avastin in place of the NICE recommended products Lucentis and Eylea.

The Royal National Institute of Blind People (RNIB) has been campaigning to block such action on safety grounds. Head of membership and campaigns for the RNIB, Steve Winyard, told OT: “We had raised our safety concerns with Devon MPs, highlighting that there is no mandatory process in place for reporting adverse events when using Avastin in the eye. There also isn't any official guidance on how to prepare, store or administer (in terms of correct dosing) Avastin for use in the eye.

“We continue to call for the Secretary of State for Health to instruct the UK regulators (Medicines and Healthcare products Regulatory Agency and National Institute for Health and Care Excellence) to review the use of Avastin for use in the eye.”

Mr Winyard added: “AMD is the most common cause of blindness in the over 50s and it is very important that patients are able to access the approved sight saving treatments for wet AMD, as some will respond to one treatment but not the other. Ensuring access to all approved therapies (ie NICE approved treatments Lucentis and Eylea) could mean the difference between a patient saving or losing their sight.”

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