There has been much discussion over the subject of AMD treatments the table below lays out the costs to the NHS for drugs in hospitals in 2012. The cost of Lucentis at that time was £193 million. Since then drug prescribing for AMD has changed Eyelea is now probably the top drug.
Table 2. Top 10 medicines by cost for medicines positively appraised by NICE issued
in hospital in 2012
||NHS Cost £ (thousands)
|Etanercept (Enbrel, Pfizer)
|Ranibizumab (Lucentis, Novartis)
|Rituximab (MabThera, Roche)
|Infliximab (Remicade, MSD)
The interesting wording on the table is ‘positively appraised by NICE’ . There was much discussion about the drug Avastin a very similar drug to Lucentis it had been developed for a very different probem. It first gained approval in the US to fight colon cancer, but was subsequently discovered to be effective against AMD.
The interesting thing about it was that its cost was roughly 15x cheaper than Lucentis. The NHS could have saved £180 million pounds by switching from just one drug to another. Why didn’t they do this? Well the simple answer was that Avastin was not NICE approved so clinicians were unable to use it. Why didn’t NICE approve it? NICE can only approve drugs that are submitted to it, if they are not submitted they are not used.
Avastin is a drug developed by Roche, Lucentis was developed by Novartis, who have a holding in Roche. Roche for some reason never felt the need to submit Avastin to NICE maybe they didn’t want to sell their drug to the NHS, I can’t for the life of me think why?…
The idiocy of NICE is stunning it is the National Institute for health and Care Excellence, common sense doesn’t seem to come in to it. Let us hope Novartis spent their £180 million pounds on lots of research into AMD.
Exciting news about robot surgery in the press. The reports highlighted new robot equipment to do surgery on the back of the eye. While this is not directly linked to AMD at this stage it is extremely good news.
The operation done in Oxford was a macula peel operation. This is when the fine membrane that is between the retina and the vitreous humor is removed. This operation has only been possible over the last ten years or so. It is an incredibly delicate piece of work, I have great admiration for the guys who perform this daily. They are working with operating microscopes all the time, it is like peeling off that layer of membrane that attaches to a boiled egg, between the shell and the egg. They are doing this inside the eye. Read the report at The Guardian or see the report BBC news report.
The reason it is so important is that in the next few years stem cell therapy will be started for AMD. The ability to use robots for this type of surgery will raise the success rates when it eventually starts as it will be comparable in complexity to macula peel operations now. This is one of those stepping stones necessary to make future treatments more likely and more successful.
The company that developed the robots is Preceyes look them up for more information.
There are many products aimed at people with MD from treatments to equipment. There are too many on the market for me to analyse all of them in depth. However, I will point out the stuff that I have been acquainted with over many years, the stuff that has endured and the stuff that is new to the market that seems to be good.
VITAMINS, vitamins Vitamins they come in all shapes and sizes so many supplements on the market for AMD. These are recommended by all sorts of people with varying claims of success. You need to be aware of why you are taking them and the likely success of taking them.
Stripping away the hype over dietary supplements you need to understand the 2 Cochrane reviews about supplements and AMD. The Cochrane reviews are the gold standard for assessments of treatment, they are objective and independent. The two reviews were looking at different aspects of supplements and macular degeneration. They are both worth looking at for definitive information, they are;
The conclusion of the paper on prevention is: There is no evidence with respect to other antioxidant supplements, such as vitamin C, lutein and zeaxanthin, or any of the commonly marketed multivitamin combinations. Although generally regarded as safe, vitamin supplements may have harmful effects and clear evidence of benefit is needed before they can be recommended.
To put it even more bluntly there is no point in taking supplements if there are no changes due to AMD. If you have family who feel they are at risk of AMD. Taking supplements will not prevent the disease. If there are no changes to the eye, supplements are not needed.
People with AMD may experience delay in progression of the disease with antioxidant vitamin and mineral supplementation. This finding is drawn from one large trial conducted in a relatively well-nourished American population. The generalisability of these findings to other populations is not known. Although generally regarded as safe, vitamin supplements may have harmful effects.
To sum this one up about 30% of people who take supplements may slow the rate of change of the disease. You are not going to reverse the course of any existing change to the macular area. They are worth taking though if change is present in the macula area, it will help in 30% of cases.
Knowing that you can only slow the progression of the disease the question then is which supplement to use?
For information on that go to the following blog posts….