DTB attacks NICE position on blindness drugs
The draft recommendation to restrict treatment for macular degeneration to the better seeing eye, made by the National Institute for Health and Clinical Excellence, has been questioned in this month's Drug
and Therapeutics Bulletin (2007;45:49).
As far as the efficacy and cost of pegaptanib and ranibizumab, the drugs
used to treat neovascular age-related macular degeneration (AMD), are
concerned the authors point out that, although both drugs are approved
for use in NHS Scotland, NICE’s appraisal consultation document
recommends that only ranibizumab is used in England and Wales, restricted
to the better seeing eye. “We believe that policies that dictate
that patients must go blind in one eye before being given treatment for
the other are unacceptable,” the authors state.
The review also looks at bevacizumab, an anticancer monoclonal antibody
that is used off-licence for AMD. The authors say: “The use of
this drug, which is not formulated for intravitreal use, presents ethical
problems for clinicians, who should advise patients that the drug is
not licensed for macular degeneration.” However, they say that
some clinicians see this as preferable to the adoption of a policy that
restricts AMD therapies to treatment of the second eye only.
NICE’s final guidance on AMD therapies is expected in December.
Head
lice The DTB (ibid,
p52) this month looks at options for treating head
lice,
in particular dimeticone lotion. Treatment
of head lice with products containing malathion, permethrin or phenothrin insecticides
is associated with the development of resistance among parasites, and many
people find such products unacceptable because of concerns about side
effects.
The DTB says that one published study suggests that dimeticone, which has a
physical rather than chemical mode of action, is as effective as 0.5 per cent
phenothrin
liquid, with a 70 per cent cure rate. The DTB considers dimeticone to be an
alternative first-line head lice treatment for people who do not wish to use
conventional
insecticides. |
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