Technology Appraisal Guidance No. 155
Source: National Institute for Health and Clinical Excellence
Guidance
1.1 Ranibizumab, within its marketing authorisation, is recommended as an option for the treatment of wet age-related macular degeneration if:
- all of the following circumstances apply in the eye to be treated:
− the best-corrected visual acuity is between 6/12 and 6/96
− there is no permanent structural damage to the central fovea
− the lesion size is less than or equal to 12 disc areas in greatest linear dimension
− there is evidence of recent presumed disease progression (blood vessel growth, as indicated by fluorescein angiography, or recent visual acuity changes)
and - the cost of ranibizumab beyond 14 injections in the treated eye is met by the manufacturer.
1.2 It is recommended that treatment with ranibizumab should be continued only in people who maintain adequate response to therapy. Criteria for discontinuation should include persistent deterioration in visual acuity and identification of anatomical changes in the retina that indicate inadequate response to therapy. It is recommended that a national protocol specifying criteria for discontinuation is developed.
1.3 Pegaptanib is not recommended for the treatment of wet age-related macular degeneration.
1.4 People who are currently receiving pegaptanib for any lesion type should have the option to continue therapy until they and their clinicians consider it appropriate to stop.
The guidance shown above constitutes Section 1 of the full document. A copy of the full document and a summary of the evidence is available on the Internet at http://www.nice.org.uk/guidance/index.jsp?action=byID&o=12057#documents
An abridged version of this guidance (a 'quick reference guide') is also available. Printed copies of the quick reference guide can be obtained by contacting 0845 003 7783 or emailing publications@nice.org.uk and quoting reference number N1664. It is also available on the Internet at http://www.nice.org.uk/Guidance/TA155/QuickRefGuide/pdf/English
This guidance represents the view of the Institute which was arrived at after careful consideration of the available evidence. Health professionals are expected to fully take it into account when exercising their clinical judgement. This guidance does not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
© Copyright National Institute for Health and Clinical Excellence. All rights reserved. This material may be freely reproduced for educational and not for profit purposes within the NHS. No reproduction by or for commercial organisations is permitted without the express written permission of the Institute.
Enquiries concerning the guidance should be addressed to: National Institute for Health and Clinical Excellence, MidCity Place, 71 High Holborn, London WC1V 6NA. email: nice@nice.nhs.uk
Ranibizumab and Pegaptanib for the Treatment of Age-Related Macular Degeneration.
Issue Date: August 2008
Review Date: August 2011
