GP leaders in York are pushing to use an unlicensed drug to treat a disease which causes blindness.

The Vale of York Clinical Commissioning Group (CCG) will discuss plans to replace the drug Lucentis with considerably cheaper - but "equally safe and effective" - Avastin to treat age related macular degeneration.

They said it could save up to £4million a year by switching to the drug - enough to pay for a year of community nursing, the A&E department for six months and 5000 cataract operations. Nationally that could amount to £800 million, the CCG has said.

But as the drug remains unlicensed, it is challenging the General Medical Council guidance, which is based on European law - which states unlicensed drugs should only be used if there are no suitable licensed drugs available - and urging the National Institute for Health and Care Guidance (NICE) to approve it.

Dr Andrew Phillips, of the Vale of York CCG, said: “In September 2014, the Cochrane Review; the top authority on medical research, stated that the two drugs are equally safe.

“Now there are only two things standing between us and a new service. Firstly the GMC must alter its guidance, albeit only slightly. Secondly NICE must carry out an appraisal of [Avastin].

“Once this is done we can institute a new service that would save the CCG £4million a year."

Avastin was originally created to treat cancer but was found to be effective against age related macular degeneration - the leading cause of blindness in the elderly.

The Governing Body meeting on Thursday is asked to approve a full assessment of using Avastin from April and to agree to an open letter to the GMC calling for a change in the guidance to allow clinicians to comply with paragraph 18 of Good Medical Practice which states, “You must make good use of the resources available to you”.

A General Medical Council spokesperson said: "We support the argument for making efficient use of NHS resources. However, it is European law – and not GMC guidance – which states that prescribing an unlicensed medicine on cost grounds where a suitable licensed medicine is available, is unlawful.

"Clearly, we cannot issue guidance that might lead doctors to act unlawfully. That is why we advise that doctors should only prescribe unlicensed medicines when they conclude, for medical reasons, that it is necessary to do so in order to meet the specific needs of the individual patient.

"At this stage, we have no plans to change our guidance. If the legal position underpinning our guidance were to change, then our guidance would need to reflect this."

It is understood other CCGs are also planning to switch from Lucentis to Avastin for the treatment of age related macular degeneration.


Comment: GPs right to make a stand on this drug

THE cost of new medicines is a fiendishly complicated and controversial business. Drugs companies invest huge sums in research. When they develop a medicine that works, they naturally expect a return.

Nevertheless, the NHS has a limited budget. It has a duty to use that budget efficiently, so that it can treat as many patients as possible.

It is good, therefore, to see GPs in York making a stand by pressing to be allowed to us a cheaper, unlicensed drug to treat a common disease – taking on the pharmaceutical industry, European law and British red tape in the process.

Age-related macular degeneration is the most common cause of sight loss in people aged 50 and over.

The drug licensed in the UK to treat the disease is Lucentis. A much cheaper drug, Avastin, has been shown to be just as effective.

The Vale of York Clinical Commissioning Group (CCG) claims that by switching to Avastin instead, it could save up to £4 million a year – money which could be used for other treatments. Nationally, it says, the NHS could save up to £800 million a year.

The problem is that Avastin is not licensed for the treatment of macular degeneration. It is made by the same company – Genetech – which makes Lucentis, but was developed as a treatment for bowel and breast cancer, and is only licensed to be used for that. The General Medical Council (GMC) says that under European law, prescribing an unlicensed drug purely on cost grounds when a licensed drug already exists is illegal.

The CCG plans to challenge the GMC, and is urging the National Institute for Clinical Health and Excellence (NICE) to approve Avastin for treating macular degeneration. York’s GPs deserves huge credit for taking such a stance. We hope that, for the sake of patients, both the GMC and NICE listen.