Cost comparison of ranibizumab and bevacizumabBMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d5058 (Published 23 August 2011) Cite this as: BMJ 2011;343:d5058
All rapid responses
I note, with some concern, the letter from Jackson and Kirkpatrick?1
recommending the adoption of Bevacizumab to treat patients with wet age-related macular degeneration (wAMD). By their own admission 'They do not
consider any potential differences in safety, medicolegal risk, treatment
burden, or patient preference, and neither do they recognise commercial
drug development costs' when so doing.
The medico-legal risks are considerable, not least for the doctors
prescribing and administering such treatment. Even if such practices
adhere strictly to constraints laid down in the statutory regulation of
medicines2 (which seems unlikely in all cases) there is still the advice
of the General Medical Council (GMC) to consider3. 'When prescribing a
drug outside the terms of its licence you must be satisfied that it would
better serve the patient's needs than an appropriately licensed
alternative'. As Ranibizumab has been licensed for the treatment of wAMD
and Bevacizumab has not, there is really nothing more to be said.
The GMC further warn that' 'Serious or persistent failure to follow this
guidance will put your registration at risk'.
What is totally unacceptable is that National Health Service
administrators, some of whom are doctors themselves should be putting
pressure on clinicians to contravene the clear guidance of their
regulatory body, and thereby put their livelihood at risk.
1. Jackson T L, Kirkpatrick L. Cost comparison of ranibizumab and
bevacizumab. BMJ 2011;343:d5058 doi: 10.1136/bmj.d5058
2. The Medicines for Human Use (Marketing Authorisations Etc.) Regulations
1994 [SI 1994/3144]
3. GMC Good Medical Practice 2006.
Available at: http://www.gmc-uk.org/guidance/good_medical_practice.asp
Competing interests: I have received payment from Novartis for lectures on the topic of Use of Unlicensed Medicines. However, the concerns about colleagues being pressurised to treat patients in a way which contravenes GMC guidance is a personal hobby-horse, and has been for some time.