Maverick medics in the UK find a cheap way to save sight

Jul 31 2007

British doctors are avoiding restrictions on an expensive sight-saving drug by offering patients an unlicensed alternative for as little as £10.

The maverick medics who are ophthalmic surgeons in Manchester are prescribing the drug Avastin to victims of the most common cause of blindness in the elderly, age-related macular degeneration (AMD).

Avastin, which is widely used to treat bowel cancer, has not as yet been given a safety licence for treating AMD but the rebel doctors say it offers hope to patients denied treatment with the tailor-made, but much more expensive, drug Lucentis.

According to the National Institute for Health and Clinical Excellence (NICE) guidelines, Lucentis may only be prescribed on the NHS to the worst 20 per cent of cases and only then when they have already lost sight in one eye.

Lucentis also costs more than £700 per injection, while Avastin which is made by the same company costs a fraction of that amount.

The doctors believe as many people as possible should be treated for AMD; Medicare in the U.S. uses Avastin to treat AMD in 48 out of 50 states and both Avastin and Lucentis are available in Scotland.

However, the Royal National Institute for the Blind cautions against using the drug saying that while no adverse effects have been reported in association with the use of Avastin for the treatment of AMD, anecdotal evidence suggests a link to severe adverse effects, including heart attacks.

The NHS is now funding a trial comparing Avastin to Lucentis in the treatment of AMD but charities say the rationing of Lucentis and Macugen, a second AMD drug, will lead to 20,000 patients a year going blind.

The action of the doctors represents the first real challenge in Britain to the high prices demanded by drug companies and reflects the growing unease at the cost of new drugs.

High prices have led in some cases to the banning or rationing of some drugs in the NHS by NICE.

Meanwhile drug giants justify their behaviour on the grounds of research and development costs while critics accuse them of profiteering.

Unaffordably high drug prices have brought the pharmaceutical industry into disrepute, forced their prices down and led to successful campaigns to allow generic copycat companies to sell cheap versions of drugs.

Around 26,000 people develop age-related macular degeneration every year - a condition that can make them blind within months.

Despite the lack of trials or a licence, the use of Avastin has spread through the US and data now exists on more than 7,000 patients.

World-famous Moorfields eye hospital in London is also thought to be exploring a scheme to use Avastin on the NHS.