In wake of recent contradictory results from two studies that compared the cheaper Avastin (bevacizumab) against the considerably more expensive Lucentis (ranibizumab) for the treatment of age-related macular degeneration (AMD), eye experts are, for the most part, confident that Avastin is as effective as Lucentis.
The debate over the drugs, both made by Roche Holding AG, moves into clinical practice after a federally funded study showed last week the two were equally effective. It also raised some safety questions about Avastin, which was designed to treat cancer.
While most doctors won’t move patients already taking Lucentis off that drug, they will explain to new patients that Avastin can provide a cheaper, albeit slightly riskier alternative as evidenced by the fact that one study found a higher risk for stroke and even death in Avastin patients.
Some 13 million Americans have signs of AMD — the leading cause of blindness in people over 60 — and more than 1 million Americans have the wet form, the most severe type.
In wet AMD, abnormal blood vessels grow beneath the retina and leak blood and fluid. Both Lucentis and Avastin are vascular endothelial growth factor, or VEGF, inhibitors that work by blocking the growth of blood vessels.Adding to concern over Avastin’s safety is an analysis of more than 77,000 Medicare claims led by a team at Johns Hopkins University and Roche’s Genentech unit presented on Tuesday.
A summary of the results released before the meeting showed Avastin increased the risk of death by 11 percent and the risk of stroke by 57 percent compared with Lucentis.
Reporting results of the year-long trial today in the New England Journal of Medicine, Daniel Martin, chairman of the Cole Eye Institute at the Cleveland Clinic in Ohioand his colleagues found identical vision improvements in people taking either drug, although those receiving monthly injections of medication performed somewhat better than those taking the drugs as needed. No significant differences between the two drugs were seen in the rates of death, heart attack or stroke, although more people taking Avastin were hospitalized during the trial than those on Lucentis. The trial investigators now plan to follow the study subjects for a second year of treatment as well as look at the genetics of the participants to better understand why some people need more injections than others.
