Indication
Vascular endothelial growth factor A inhibitor (anti-VEGF), Wet Age-related Macular Degeneration, Diabetic macular oedema, Macular oedema secondary to retinal vein occlusion (branch RVO or central RVO), Choroidal neovascularisation (CNV) associated with pathological myopia
RAG rating
Red
Document type
Decision document
Place
Hertfordshire and West Essex ICB
Output type
Pharmacy / Prescribing

Ranibizumab

HERTFORDSHIRE AND WEST ESSEX AREA PRESCRIBING COMMITTEE (HWE APC)

Ranibizumab for medical retinal conditions in adult patients

RED

Recommended for restricted prescribing by specialist only.

Not recommended for primary care prescribing.

Name generic (trade) Ranibizumab

What it is Vascular endothelial growth factor A inhibitor (anti-VEGF)

Indication Wet Age-related Macular Degeneration, Diabetic macular oedema, Macular oedema secondary to retinal vein occlusion (branch RVO or central RVO), Choroidal neovascularisation (CNV) associated with pathological myopia

Date decision last revised December 2022

Decision status Final

NICE / SMC Guidance NICE TA 155 recommended, NICE TA 274 recommended, NICE TA 283 recommended, NICE TA 298 recommended.

HWE APC recommendation:

Treatment options consistent with the recommendations within the NHSE Operational note: Commissioning recommendations following the national procurement for medical retinal vascular medicines1 and NICE TA recommendations for all NICE TA approved indications:

  • ranibizumab biosimilar and aflibercept are the preferred first line anti-VEGF agents (bevacizumab can also be used for wet AMD if agreed with place as an option)
  • aflibercept is the preferred second line anti-VEGF agent if 1st line ranibizumab biosimilar used
  • if suboptimal response to both ranibizumab and aflibercept (or where contraindicated/not clinically appropriate / intolerance) a third anti-VEGF agent can be considered where supported by a NICE TA recommendation for use in that indication.
  • clinicians should consider reviewing patients currently prescribed ranibizumab (Lucentis®) to assess suitability for a change to ranibizumab biosimilar
  • NICE considers all anti-VEGF treatments as equally effective as evidence from clinical trials shows that faricimab and brolucizumab are as effective as aflibercept and indirect comparisons of both faricimab and brolucizumab with ranibizumab also suggests similar clinical effectiveness.

RED STATUS:

NOT RECOMMENDED FOR PRIMARY CARE PRESCRIBING.

RECOMMENDED FOR RESTRICTED PRESCRIBING BY SPECIALISTS

1. NHSE Operational note: Commissioning recommendations following the national procurement for medical retinal vascular medicines August 2022 v1.

Review date: The recommendation is based upon the evidence available at the time of publication. This recommendation will be reviewed upon request in the light of new evidence becoming available.

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