Pathologic myopia (PM) is caused by the progressive and excessive elongation of the axial length of the eyeball. Myopic choroidal neovascularization (CNV) is a complication of PM and is a serious threat to vision. CNV is observed as an abnormal growth of blood vessels located between the neurosensory retina and the retinal pigment epithelium. Symptoms include a decrease in vision, central scotoma, and/or metamorphopsia. PM has a prevalence of 0.084% among adult Canadians, and myopic CNV is a leading cause of visual disability among young adults.>

Verteporfin (Visudyne) photodynamic therapy (vPDT) is the standard of care for myopic CNV in Canada. vPDT retards vision loss in patients with subfoveal CNV and stabilizes, rather than improves, visual acuity (VA). The anti-vascular endothelial growth factor (VEGF) therapies, ranibizumab (Lucentis) and bevacizumab (Avastin), have been used off-label as monotherapies for myopic CNV in Canada. Ranibizumab is approved in Canada for the treatment of neovascular (wet) age-related macular degeneration, the treatment of visual impairment due to macular edema secondary to retinal vein occlusion, and the treatment of visual impairment due to diabetic macular edema. Ranibizumab was recently approved by Health Canada for treating visual impairment due to CNV secondary to PM. Ranibizumab is supplied as a 10 mg/mL solution in single-use vials for intravitreal injection. The recommended dose is a single initial 0.5 mg injection followed by monthly injections, administered as needed based on signs of disease activity.

The objective of this review was to perform a systematic review of the beneficial and harmful effects of ranibizumab intravitreal injection for the treatment of visual impairment due to CNV secondary to PM in adults.

Contents

• Clinical Review Report
  • ABBREVIATIONS
  • EXECUTIVE SUMMARY
    • Introduction
    • Results and interpretation
    • Other considerations
    • Conclusions
  • 1. INTRODUCTION
    • 1.1 Disease Prevalence and Incidence
    • 1.2 Standards of Therapy
    • 1.3 Drug
  • 2. OBJECTIVES AND METHODS
    • 2.1 Objectives
    • 2.2 Methods
  • 3. RESULTS
    • 3.1 Findings From the Literature
    • 3.2 Included Study
    • 3.3 Patient Disposition
    • 3.4 Exposure to Study Treatments
    • 3.5 Critical Appraisal
    • 3.6 Efficacy
    • 3.7 Harms
  • 4. DISCUSSION
    • 4.1 Summary of Available Evidence
    • 4.2 Interpretation of Results
    • 4.3 Other Considerations
  • 5. CONCLUSIONS
  • APPENDIX 1 PATIENT INPUT SUMMARY
  • APPENDIX 2 LITERATURE SEARCH STRATEGY
  • APPENDIX 3 DETAILED OUTCOME DATA
  • APPENDIX 4 VALIDITY OF OUTCOME MEASURES
  • REFERENCES
• Pharmacoeconomic Review Report
  • ABBREVIATIONS
  • EXECUTIVE SUMMARY
    • Background
    • Summary of Identified Limitations and Key Results
    • Conclusions
  • 1. SUMMARY OF THE MANUFACTURER’S PHARMACOECONOMIC SUBMISSION
  • 2. MANUFACTURER’S BASE CASE
    • 2.1 Summary of manufacturer’s sensitivity analyses
  • 3. LIMITATIONS OF MANUFACTURER’S SUBMISSION
    • 3.1 CADTH Common Drug Review Analyses
  • 4. ISSUES FOR CONSIDERATION
    • 4.1 Patient Input
  • 5. CONCLUSIONS
  • APPENDIX 1 COST COMPARISON
  • APPENDIX 2 SUMMARY OF KEY OUTCOMES
  • APPENDIX 3 ADDITIONAL INFORMATION
  • APPENDIX 4 SUMMARY OF OTHER HEALTH TECHNOLOGY ASSESSMENT REVIEWS
  • APPENDIX 5 REVIEWER WORKSHEETS
  • REFERENCES
• CDEC Final Recommendation
  • Recommendation
  • Reasons for the Recommendation
  • Of Note
  • Background
  • Summary of CDEC Considerations
  • Other Discussion Points
  • Research Gaps

This review report was prepared by the Canadian Agency for Drugs and Technologies in Health (CADTH). In addition to CADTH staff, the review team included a clinical expert in ophthalmology who provided input on the conduct of the review and the interpretation of findings.

Through the CADTH Common Drug Review (CDR) process, CADTH undertakes reviews of drug submissions, resubmissions, and requests for advice, and provides formulary listing recommendations to all Canadian publicly funded federal, provincial, and territorial drug plans, with the exception of Quebec.

The report contains an evidence-based clinical and/or pharmacoeconomic drug review, based on published and unpublished material, including manufacturer submissions; studies identified through independent, systematic literature searches; and patient-group submissions. In accordance with CDR Update – Issue 87, manufacturers may request that confidential information be redacted from the CDR Clinical and Pharmacoeconomic Review Reports.

The information in this report is intended to help Canadian health care decision-makers, health care professionals, health systems leaders, and policy-makers make well-informed decisions and thereby improve the quality of health care services. The information in this report should not be used as a substitute for the application of clinical judgment with respect to the care of a particular patient or other professional judgment in any decision-making process, nor is it intended to replace professional medical advice. While CADTH has taken care in the preparation of this document to ensure that its contents are accurate, complete, and up-to-date as of the date of publication, CADTH does not make any guarantee to that effect. CADTH is not responsible for the quality, currency, propriety, accuracy, or reasonableness of any statements, information, or conclusions contained in the source documentation. CADTH is not responsible for any errors or omissions or injury, loss, or damage arising from or relating to the use (or misuse) of any information, statements, or conclusions contained in or implied by the information in this document or in any of the source documentation.

This document is intended for use in the context of the Canadian health care system. Other health care systems are different; the issues and information related to the subject matter of this document may be different in other jurisdictions and, if used outside of Canada, it is at the user’s risk. This disclaimer and any questions or matters of any nature arising from or relating to the content or use (or misuse) of this document will be governed by and interpreted in accordance with the laws of the Province of Ontario and the laws of Canada applicable therein, and all proceedings shall be subject to the exclusive jurisdiction of the courts of the Province of Ontario, Canada.

CADTH takes sole responsibility for the final form and content of this document, subject to the limitations noted above. The statements and conclusions in this document are those of CADTH and not of its advisory committees and reviewers. The statements, conclusions, and views expressed herein do not necessarily represent the views of Health Canada or any Canadian provincial or territorial government. Production of this document is made possible by financial contributions from Health Canada and the governments of Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Nunavut, Ontario, Prince Edward Island, Saskatchewan, and Yukon.