NICE recommends two treatments for diabetic macular oedema

New guidance from NICE approves the use of aflibercept (Eylea) and dexamethasone intravitreal implant (Ozurdex) in patients with diabetic macular oedema (DMO).

Diabetic macular oedema is the most common cause of preventable blindness among people of working age. | Saine, CUSTOM MEDICAL STOCK PHOTO/ SCIENCE PHOTO LIBRARY
Diabetic macular oedema is the most common cause of preventable blindness among people of working age. | Saine, CUSTOM MEDICAL STOCK PHOTO/ SCIENCE PHOTO LIBRARY

Patients with visual impairment due to DMO who have a central retinal thickness of 400 micrometers or more will now have access to aflibercept, provided the manufacturer complies with the discount agreed in the patient access scheme.

Individuals with DMO who have an intraocular (pseudophakic) lens will be eligible to receive dexamethasone intravitreal implant on the NHS if non-corticosteroid treatment is ineffective or unsuitable.

Treatment regimens

Further information
NICE technology appraisal TA346
NICE technology appraisal TA349

Eylea is given by intravitreal injection once monthly for 5 months. After this, injections are given once every two months and patients are not required to visit a hospital for monitoring between injections. After the first 12 months of treatment, the time between injections may be extended depending on the patient’s response.

Ozurdex is given as a single intravitreal implant. Retreatment may be performed after 6 months if the patient experiences decreased vision or increased retinal thickness, secondary to recurrent or worsening DMO.

"Eylea, with its simple treatment plan, has already enabled doctors to deliver positive visual outcomes for other conditions in real-life clinical practice, similar to those seen in clinical trials," said Sobha Sivaprasad, Consultant Ophthalmologist at Moorfields Eye Hospital and King’s College Hospital London. "It is therefore great news that we are now able to offer it to DMO patients to hopefully achieve similar outcomes."

"Not only is Ozurdex a valuable treatment option for patients who are facing loss of sight, it also has the added benefit of helping to reduce the number of injections and clinic visits that these patients have to manage," commented Ian Pearce, Consultant Ophthalmologist at St Paul’s Eye Unit, Royal Liverpool University Hospital.

Use in NHS Scotland

The Scottish Medicines Consortium has accepted aflibercept and dexamethasone intravitreal implant for use in DMO. Use of aflibercept is restricted to patients with best corrected visual acuity (BCVA) 75 Early Treatment Diabetic Retinopathy Study (ETDRS) letters or less at baseline.

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