Neovascular (wet) age-related macular degeneration
(specialist use only) | Diabetic macular oedema
(specialist use only) | Macular oedema secondary to
retinal vein occlusion (specialist use only) | Choroidal
neovascularisation (specialist use only)
▶BY INTRAVITREAL INJECTION
▶Adult: Initially 500 micrograms once a month, to be
administered into the affected eye, until maximum
visual acuity is achieved or there are no signs of disease
activity, for continued treatment and subsequent dose
intervals—consult product literature, discontinue
treatment if no improvement in visual and anatomic
outcomes
Concomitant treatment of diabetic macular oedema, or
macular oedema secondary to branch retinal vein
occlusion, with laser photocoagulation (specialist use
only)
▶BY INTRAVITREAL INJECTION
▶Adult: 500 micrograms, to be administered at least
30 minutes after laser photocoagulation
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Ocular or periocular infection.
severe intra-ocular inflammation. signs of irreversible
ischaemic visual function loss in patients with retinal vein
occlusion (no information available)
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Active systemic infection. diabetic macular
oedema due to type 1 diabetes (limited information
available). diabetic patients with HbA1c over 12%. history
of stroke. history of transient ischaemic attack. patients at
risk of retinal pigment epithelial tear. previous intravitreal
injections. proliferative diabetic retinopathy. retinal
detachment or macular hole (discontinue treatment if
rhegmatogenous retinal detachment or stage 3 or 4
macular holes develop). uncontrolled hypertension
CAUTIONS, FURTHER INFORMATION Ranibizumab is given
by intravitreal injection by specialists. There is a potential
risk of arterial thromboembolic events and non-ocular
haemorrhage following the intravitreal injection of
vascular endothelial growth factor inhibitors.
Endophthalmitis can occur after intravitreal injections—
patients should be advised to report any signs of infection
immediately.
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NICE decisions
▶Ranibizumab for treating choroidal neovascularisation
associated with pathological myopia (November 2013)
NICE TA298
Ranibizumab is recommended as an option for treating
visual impairment due to choroidal neovascularisation
secondary to pathological myopia when the manufacturer
provides ranibizumab with the discount agreed in the
patient access scheme.
www.nice.org.uk/guidance/ta298
▶Ranibizumab for the treating visual impairment caused by
macular oedema secondary to retinal vein occlusion (May
2013) NICE TA283
Ranibizumab is recommended as an option for treating
visual impairment caused by macular oedema:
. following central retinal vein occlusion or
. following branch retinal vein occlusion only if treatment
with laser photocoagulation has not been beneficial, or
when laser photocoagulation is not suitable because of
the extent of macular haemorrhage and
. only if the manufacturer provides ranibizumab with the
discount agreed in the patient access scheme revised in
the context of NICE technology appraisal guidance 274.
Patients currently receiving ranibizumab whose disease
does not meet the criteria listed above should be able to
continue treatment until they and their clinician consider
it appropriate to stop.
www.nice.org.uk/guidance/ta283
▶Ranibizumab for treating diabetic macular oedema (February
2013) NICE TA274
Ranibizumab is recommended as an option for the
treatment of visual impairment due to diabetic macular
oedema only if:
. the eye has a central retinal thickness of
400 micrometres or more at the start of treatment and
. the manufacturer provides ranibizumab with the
discount agreed in the patient access scheme (as revised
in 2012).
Patients currently receiving ranibizumab for treating
visual impairment due to diabetic macular oedema whose
disease does not meet the criteria should be able to
continue treatment until they and their clinician consider
it appropriate to stop.
www.nice.org.uk/guidance/ta274
▶Ranibizumab and pegaptanib for the treatment of age-related
macular degeneration (updated May 2012) NICE TA155
Ranibizumab is recommended for the treatment of wet
age-related macular degeneration if all of the following
apply:
. the best corrected visual acuity is between 6/12 and
6/96;
. there is no permanent structural damage to the central
fovea;
. the lesion size is less than or equal to 12 disc areas in
greatest linear dimension;
. there is evidence of recent presumed disease
progression;
. the manufacturer provides ranibizumab with the
discount agreed in the patient access scheme (as revised
in 2012).
Ranibizumab should only be continued in patients who
maintain adequate response to therapy.
www.nice.org.uk/guidance/ta155
Scottish Medicines Consortium (SMC) decisions
SMC No. 381/07
The Scottish Medicines Consortium has advised (June 2007)
that ranibizumab (Lucentis ®) is accepted for use within
NHS Scotland for the treatment of neovascular (wet) age-
related macular degeneration.
SMC No. 711/11
The Scottish Medicines Consortium has advised
(December 2012) that ranibizumab (Lucentis ®) is accepted
for restricted use within NHS Scotland for the treatment of
visual impairment due to diabetic macular oedema in
adults with best corrected visual acuity 75 Early Treatment
Diabetic Retinopathy Study letters or less at baseline. This
advice is contingent upon the continuing availability of
the patient access scheme in NHS Scotland or a list price
that is equivalent or lower.
SMC No. 732/11
Eye
The Scottish Medicines Consortium has advised (May
2013) that ranibizumab (Lucentis ®) is accepted for use
within NHS Scotland for the treatment of macular oedema
secondary to branch or central retinal vein occlusion in
adults. This advice is contingent upon the continuing
availability of the patient access scheme in NHS Scotland
or a list price that is equivalent or lower.
SMC No. 907/13
The Scottish Medicines Consortium has advised
(November 2013) that ranibizumab (Lucentis ®) is accepted
for use within NHS Scotland for the treatment of visual
impairment due to choroidal neovascularisation secondary
to pathologic myopia in adults. This advice is contingent
upon the continuing availability of the patient access
scheme in NHS Scotland or a list price that is equivalent or
lower.
All Wales Medicines Strategy Group (AWMSG) decisions
AWMSG No. 3233
The All Wales Medicines Strategy Group has advised (June
2018) that ranibizumab (Lucentis ®) is recommended as an
option for use within NHS Wales for the treatment of
visual impairment in adults due to choroidal
neovascularisation not due to pathological myopia or wet
age-related macular degeneration. This recommendation
applies only in circumstances where the approved Patient
Access Scheme (PAS) is utilised or where the list/contract
price is equivalent or lower than the PAS price.
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