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Nice says Bayer’s Eylea not recommended as first-line treatment in draft recommendation

Published on 10/06/16 at 08:48am

The National Institute for Health and Care Excellence (Nice) in a provisional guidance said Bayer’s (ETR: BAYN) Eylea (aflibercept) is not recommended as a first line treatment.

However, it is recommended only if laser photocoagulation has not been beneficial or if laser photocoagulation is not suitable because of the extent of macular haemorrhage.

This recommendation is not aligned with the Royal College of Ophthalmologists (RCOphth) 2015 guidelines, which recommend prompt first-line treatment with anti-VEGF agents. 

Alexander Moscho chief executive Bayer UK/Ireland said: “We are disappointed with the preliminary recommendation from Nice. We feel it is out of touch with current practice and moves away from the pathway recommended by the Royal College of Ophthalmologists in recognition of what is best clinically for patients. An ongoing consultative process will now begin with Nice and Bayer will be actively participating to ensure that patients facing sight-loss are able to receive treatment in line with Royal College recommendations and international standards of care.” 

Aflibercept is an anti-VEGF treatment specifically designed to improve vision. 

Professor Sobha Sivaprasad, Consultant Ophthalmologist, Moorfields Eye Hospital, London said:Patients with BRVO who receive laser treatment as their first treatment after diagnosis are unlikely to have the same improvements in vision that are possible with newer anti-VEGF treatments, even if they later go on to have an anti-VEGF. A very large proportion of patients who receive laser as their first treatment will eventually require an anti-VEGF, but if anti-VEGF is delayed then some patients may never achieve the improvement in their sight that they might have done otherwise.” 

According to 2011, 2013 recommendations, the regulator backed laser photocoagulation as the first-line treatment in visual impairment due to BRVO and ranibizumab or dexamethasone intravitreal implant as second-line treatment options, where laser photocoagulation has not been beneficial or is not suitable. 

However, clinical practice has changed and the 2015 RCOphth Guidelines for Retinal Vein Occlusion recommend prompt treatment with anti-VEGF agents (or dexamethasone implant) for macular oedema due to non-ischaemic BRVO (BRVO with an adequate blood supply to the retina) and restrict laser photocoagulation to when these other treatments are unsuccessful. 

Anjali Shukla

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