Intended for healthcare professionals

Feature Investigation

Are the odds shifting against pharma in the fight for cheaper treatment for macular degeneration?

BMJ 2017; 359 doi: (Published 01 November 2017) Cite this as: BMJ 2017;359:j5016
  1. Deborah Cohen, associate editor, The BMJ
  1. dcohen{at}

Doctors plan to prescribe bevacizumab despite legal threats from drug companies, and against GMC and NICE guidance. Responses to the policy and new legal rulings hint at a turning point in a long-running battle in which £0.5bn potential NHS savings are at stake, reports Deborah Cohen

The tide may be turning in the story of bevacizumab (Avastin) as a treatment for wet age-related macular degeneration (AMD). In response to The BMJ’s revelation that doctors in the north east of England face legal action over their new policy to offer patients that option,1 commissioning leaders have thrown their weight behind them—and the doctors’ regulator seems to be softening its stance against such moves.

What is at stake, say the doctors involved in the latest battle, is the principle that the choice between clinically effective and safe drugs should be one for clinicians and patients, not drug companies. They estimate that prescribing bevacizumab, a monoclonal antibody against vascular endothelial growth factor (VEGF), could save the NHS millions of pounds in their 12 clinical commissioning group (CCG) areas (see commentary).2 Across England, those savings could total over £500m (€570m; $660m) if it is used for all relevant eye conditions.

In addition, the latest chapter in this story calls into question the influence of the government on guidance from the National Institute for Health and Care Excellence (NICE).

Potential savings

Two anti-VEGF drugs are approved to treat wet AMD on the NHS: ranibizumab (Lucentis), marketed by Novartis in Europe, and aflibercept (Eylea) produced by Bayer. Roche markets bevacizumab for use in various cancers—not all of which uses have evidence of clinically meaningful benefit—but has never licensed it for use in the eye despite the fact that meta-analysis of several publicly funded clinical trials found that bevacizumab is as safe and effective as ranibizumab …

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