Landmark study could save NHS £100 million

Southampton’s NIHR Clinical Research Facility was central to a UK-wide trial demonstrating that the eye condition wet age-related macular degeneration (AMD) can be treated with a drug 10 times cheaper than the current treatment, representing a potential saving of £100 million per year.  

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Key facts
 

• Wet AMD affects around 26,000 people in the UK, and is a major cause of sight loss due to fragile blood vessels in the retina damaging surrounding cells

• Lucentis is the main treatment for the condition, with a regular injections required at £700 per patient, per injection

• Avastin, a chemotherapeutic with a per patient, per dose cost of £60, was demonstrated to be equally effective to Lucentis in targeting retinal blood vessels and managing wet AMD

• Southampton’s major contribution was delivered through a regular ophthalmology research clinic held within the facility using research-dedicated equipment, supported by our ophthalmology research nursing team

• This study provided critical evidence supporting Avastin as a treatment for wet AMD,  with international impact on  prescribing for the condition
   

Jump to our infographic summary here.
 

Saving sight, saving money

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AMD is the most common cause of sight loss in the western world. There are two forms – ‘wet’ or neovascular AMD and ‘dry’ AMD. Wet AMD affects around 26,000 people in the UK, and is the more serious of the two conditions, causing rapid sight loss if left untreated.

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Wet AMD is involves growth of fragile blood vessels in the central retina (the macular) at the back of the eye. These leak fluid, damaging the light-sensitive cells in this region causing progressive loss of central vision, leaving those affected unable to read, drive or recognise faces.

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Currently the main treatment in the UK for wet AMD is injections of Lucentis, a drug that blocks growth of the fragile blood vessels, into the eye. However it’s expensive, costing £700 per patient per injection, especially in comparison with the chemotherapeutic Avastin has the same mechanism of action yet costs £60 per patient, per injection. Demonstrating Avastin’s safety and efficacy in wet AMD treatment would provide evidence for its use in place of Lucentis - representing potential savings for the NHS of £100 million a year.

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Providing new evidence

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This study, known as the IVAN trail, was the first randomised, controlled trial to compare these two drugs for treating wet AMD. It involved 610 patients over the age of 50 with untreated wet AMD from eye clinics across the UK, who were randomly assigned to be treated with Lucentis or Avastin for two years and their progress tracked.

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In Southampton the trial was conducted within the facility, led by Professor Andrew Lotery as part of his regular eye research clinic, hosted and supported by the facility. The facility provides clinical space and a specialist research nursing team to enable this clinic, hosting the research-dedicated ophthalmology equipment needed to conduct studies like these efficiently and safely.

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While Avastin for wet AMD is not yet licensed in the UK, the World Health Organization added Avastin to off-label use for AMD and in April 2013 added it to its Essential Medicines List. Avastin is now routinely prescribed in the US private healthcare system, Italy has approved it for off-label use, and it has rapidly been taken up in emerging economies.

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As a result of this work, Professor Andrew Lotery was invited to write an editorial in the British Medical Journal, which NHS health commissioners quoted in a letter to the Secretary of State for Health, Jeremy Hunt, requesting Avastin as a UK treatment for wet AMD.