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UK Suggestion for Restricted Use of Anti-AMD Drugs Draws Flak

Campaigners have denounced as insensitive National Institute for Health and Clinical Excellence (Nice)s suggestion for restricted use of Lucentis (ranibizumab) and Macugen (pegaptanib) on the NHS . TWENTY thousand people will be condemned to blindness each year if the "cruel" and "appalling" decision is implemented, they contended.

Both Lucentis and Macugen are chief drugs used in combating all types of wet age-related macular degeneration (AMD), the leading cause of sight loss in the UK with 26,000 new cases each year.

Nice's preliminary guidance recommends Macugen should not be used at all on the NHS, while Lucentis should be restricted to about one in five patients.

It suggests the 20 per cent who are given the drug are those who have a particular type of wet AMD called predominantly classic subfoveal choroidal neovascularisation (CNV).

Nice also recommends Lucentis for use only when both eyes are affected, and only for use in the better-seeing eye.

It is stressed that such an approach effectively meant patients would be treated only once they had gone blind in one eye.

Wet AMD affects the central part of the retina called the macula and can lead to blindness in as little as three months.

The two drugs are known as anti-VEGF drugs and they work by targeting VEGF (Vascular endothelial growth factor), a protein that helps the formation of new blood vessels.

In the case of AMD these new blood vessels are unstable and tend to leak fluid and blood under the retina. The resulting scarring then causes irreversible sight loss. The anti-VEGF drugs inhibit the growth of new blood vessels, thereby minimising the risk of scarring.

Treatment with anti-VEGF drugs requires regular injections into the eye. In the case of Macugen six weekly injections are given. In the case of Lucentis the license provides for three four-weekly injections followed by a review every
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