Following a bit of a backlash from some Kiwi ophthalmologists, aflibercept is back on the government’s Pharmaceutical Management Agency’s (Pharmac’s) funding agenda and has been recommended as the second line anti-VEGF treatment, replacing ranibizumab.

Pharmac consulted on a proposal to list ranibizumab (Lucentis) and aflibercept (Eylea) in Section H of the Pharmaceutical Schedule for the second and third line treatment (respectively) of wet age-related macular degeneration (wAMD) in the second half of last year, following a request for proposals for the supply of anti-endothelial growth factor (anti-VEGF) agents in May 2016. But aflibercept was dismissed as an additional listed treatment in December, despite Pharmac at the time noting a strong preference for it from some clinicians over and above the fully-funded (and said to be more expensive) alternative ranibizumab.

But following further feedback from some ophthalmologists, Pharmac’s primary clinical advisory committee, the Pharmacology and Therapeutics Advisory Committee (PTAC), in May recommended aflibercept be funded as second line anti-VEGF treatment for wAMD after bevacizumab (Avastin) - bumping it above ranibizumab - and a third line anti-VEGF agent be declined. The published minutes of the committee, stated that:

“The Committee considered that whilst the quality of evidence for second line use for both ranibizumab and aflibercept is moderate to poor, both the quantity and quality of evidence is higher for studies using aflibercept than ranibizumab in the second line setting… The Committee considered that if only one anti-VEGF agent were to be funded for second line treatment, that aflibercept would be the preferred agent.”

The Committee recommended aflibercept be funded with a medium priority and then referred the recommendation to Pharmac’s ophthalmology subcommittee for further consideration. A further meeting on aflibercept was held in November, but no final decision had been released at the time of going to press.