What is stopping the NHS from using bevacizumab for macular degeneration and other retinal disorders?

Age related macular degeneration (AMD) is the commonest cause of blindness among elderly people in the developed world.1 The treatment of neovascular AMD was revolutionised by clinical trials of ranibizumab (Lucentis), a monoclonal antibody against vascular endothelial growth factor. These showed that vision was improved with repeated monthly intravitreal injections.1 The National Institute for Health and Care Excellence (NICE) approved its use in 2008 and subsequently approved aflibercept, which also inhibits vascular endothelial growth factor, in 2013.

Since then, carefully conducted clinical trials have shown that a similar drug, bevacizumab (Avastin), is as effective as ranibizumab at improving or stabilising vision in patients with neovascular AMD. The two largest studies are CATT (Comparison of AMD Treatments Trials) in the US2 and the IVAN (Inhibition of VEGF in Age-related Choroidal Neovascularisation) trial in the UK.3 Bevacizumab, however, is not licensed for use in eyes.

There are concerns that bevacizumab is not as safe as ranibizumab. However, a recent Cochrane review found no difference between the two drugs for deaths, all serious systemic adverse events, or specific subsets of adverse events with the exception of gastrointestinal disorders.4 It concluded that, from a safety point of view, …