1.1 Brolucizumab is recommended as an option for treating wet age-related macular degeneration in adults, only if, in the eye to be treated:
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 and
there is recent presumed disease progression (for example, blood vessel growth, as shown by fluorescein angiography, or recent visual acuity changes).
It is recommended only if the company provides brolucizumab according to the commercial arrangement.
1.2 If patients and their clinicians consider brolucizumab to be one of a range of suitable treatments, including aflibercept and ranibizumab, choose the least expensive (taking into account administration costs and commercial arrangements).
1.3 Only continue brolucizumab in people who maintain an adequate response to therapy. Criteria for stopping should include persistent deterioration in visual acuity and identification of anatomical changes in the retina that indicate inadequate response to therapy.
1.4 These recommendations are not intended to affect treatment with brolucizumab that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them.
Why the committee made these recommendations
Usual treatment for age-related macular degeneration is aflibercept and ranibizumab. Clinical trial evidence and a network meta-analysis shows that brolucizumab provides similar overall health benefits to these drugs, and is similarly safe. The total costs (including administration) of brolucizumab are the same or less than those of aflibercept and ranibizumab.
Because it has similar costs and overall health benefits to aflibercept and ranibizumab, brolucizumab is recommended as an option for treating adults with wet age-related macular degeneration in line with the previous recommendations in NICE technology appraisals guidance for aflibercept and ranibizumab.