New treatment option for uveitis recommended by NICE

A new treatment option for an inflammatory eye condition has been recommended by NICE.

People with recurrent non-infectious uveitis affecting the back of the eye could benefit from a new treatment option, the fluocinolone acetonide implant (Iluvien, Alimera Sciences), as a result of new NICE guidance.

The treatment, which is injected into the eye, lasts three years. This could mean fewer hospital visits for patients who receive current treatments: including corticosteroid injections, immunosuppressants, and dexamethasone and adalimumab implants.

Clinical trial results suggest that the fluocinolone acetonide implant improves visual acuity (clearness of vision) after 12 months by 5.9 letters (on a Snellen chart) compared with 4.3 letters in the control group. A 5-letter increase in visual acuity indicates an improvement in vision.

The trial also indicated the treatment reduced uveitis recurrence rates. After 12 months, 97.6% of people in the control group had a recurrence recorded, compared with 37.9% of people who had the fluocinolone acetonide implant. But the appraisal committee concluded the recurrence rates reported in the trial were likely to be overestimated. It was also noted that no direct comparisons with other treatments were included in the trial.

Around 8,500 people in England have non-infectious uveitis affecting the back of the eye. The number of people with recurrent disease who would be eligible for this treatment are far fewer.

Uveitis is an inflammatory eye condition which may be caused by a bacterial, viral or fungal infection or trauma to the eye. More commonly it is associated with an underlying autoimmune disorder. One or both eyes may be affected.
Symptoms of uveitis include eye pain, redness of the eye, vision problems, sensitivity to light, and headaches. If left untreated more serious conditions can develop such as glaucoma (increased pressure inside the eye), cataracts (cloudiness of the lens), cystoid macular oedema (swelling of the retina) and permanent loss of vision.

Meindert Boysen, director of the Centre for Health Technology Evaluation at NICE, said: “Existing treatments for controlling recurrent non-infectious uveitis can be burdensome and disruptive to daily life for both patients and their carers, needing frequent hospital visits for administration and monitoring.
“The fluocinolone acetonide implant offers patients a new treatment option that could lead to more consistent disease control with a reduced treatment burden. We are happy to be able to provide people with recurrent non-infectious uveitis affecting the posterior segment of the eye with an additional treatment option, particularly one with potentially long-lasting benefits.”

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