Health

Matthew Offord Excerpts

Tuesday 17th July 2012 Commons Chamber

[Dr Matthew Offord (Hendon) (Con)]

I wish to raise the issue of wet age-related macular degeneration and the treatments that are available.

The condition usually affects the sight of people from the age of 60, although it can affect people at an earlier age. AMD is the most common cause of sight loss in the western world. In the UK, more than 500,000 people have the condition and about 250,000 people are registered as visually impaired. Because people are living longer, the number of people who are affected by AMD is increasing.

Although the condition causes central vision loss and can have a devastating impact, it does not lead to complete blindness as sufferers retain their peripheral vision. Unfortunately, there is no known cure, but drugs are available that can slow the growth of blood vessels in the eye. Such anti-vascular endothelial growth factor medicines prevent blood vessels from forming or growing. Three drugs have been used in the treatment of wet AMD: Macugen, Lucentis and Avastin. It is the latter two drugs with which my speech is concerned.

Fundamentally, what is the difference between the two drugs? At first glance, the answer is the cost. Lucentis costs about £700 an injection, while Avastin costs £60. The bigger answer is that Avastin is not officially approved for eye treatments. Lucentis gained its European Medicines Agency approval in 2007. It is officially approved for use in eyes and is the treatment recommended in England and Wales by the National Institute for Health and Clinical Excellence. The certification is based on extensive trials that show that is safe and effective for all lesion types in wet AMD. The trials have shown that it stabilises sight in more than 90% of cases and improves sight in 40% of cases.

The cheaper Avastin has not been approved by the EMA for use in treatments of the eye because it has not gone through the proper clinical trials. It has been approved as a treatment for colorectal cancers, and is therefore readily available. When used for colorectal cancers, the drug is injected into a vein in the arm. When it is used for the treatment of wet AMD, it is given into the eye.

The findings of two trials comparing Avastin and Lucentis have been published recently. Those are the comparison of age-related macular degeneration treatments trial, known as CATT, which was carried out in the United States, and the inhibit VEGF in age-related choroidal neovascularisation trial, known as IVAN, which was carried out in the UK and was funded by the National Institute for Health Research. The IVAN trial, which was NHS funded, involved 610 patients in 23 hospitals. It was one of the largest research projects studying eye diseases in the UK. The one-year results were presented at an international conference in May this year and have been accepted for publication in the peer-reviewed journal, Ophthalmology.

The greatest debate about the differences between the two drugs is likely to be over their safety when used to treat wet AMD. Academics say that, overall, both drugs are extremely safe. My contention is that it is likely that cost pressures on the NHS will lead to increased use of Avastin. The IVAN researchers estimated that if the NHS were to substitute Lucentis for Avastin across the UK, it would save £84.5 million each year if 17,295 eyes were treated.

However, I am aware of the financial environment in which pharmaceutical companies operate. Like other industries, they manufacture products that must be sold at a profit, but in contrast to manufacturers in other industries their research and development costs are prohibitive. That means that they must make money on their investment. I recognise that they must not only regain their expenditure through profit but achieve profits to cover all the drugs that fail to get on to the market.

There has been criticism of NICE’s failure to recognise and adopt innovative new medicines. The UK is a world leader in medicines research, development and manufacture, but it is one of the slowest countries to enable patients to have access to innovative treatments. Avastin fits into that classification. I do not seek the Department’s licensing it immediately, but I call for the Government to establish an independent appraisal of it for use in ophthalmology. Clinicians are already using it off-label, so that would not be a leap in the dark. The savings that there would be for the NHS if the drug did work have already been quantified. However, if it is not safe, we must act to ensure the public’s health. I therefore ask the Minister to consider my request.