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Avastin Steals The Show: Treatment for Wet Macular Degeneration

Avastin is the now the preferred treatment for macular degeneration in many areas. It was discovered as an anti-cancer drug and may also have implications for diabetes.

Avastin, in many areas is the preferred treatment for wet macular degeneration.  Avastin’s generic name is bevacizumab.  It is the predecessor to Lucentis and both are made by the same company (Genentech/Roche).  Avastin is the third intraocular injection and is also anti-VEGF.

Avastin;

  • is NOT FDA approved for the treatment of macular degeneration
  • is the standard of care for the treatment of macular degneration
  • is an antibody fragment against VEGF
  • blocks all isoforms of VEGF in the eye (there are six)
  • is FDA approved for the treatment of cancer

Confused? Yes, it is not FDA approved, but is the standard of care for the treatment of macular degneration.  There is a difference between FDA approval and standard of care.  In short, standard of care is what a prudent doctor would do in the same situation.  FDA approval is necessary for a drug to be used in the U.S.

Avastin Fights Cancer and was introduced in 2004 for treatment of colon cancer and lung cancer.  It is now approved for the treatment of breast cancer.  As the story goes, some patients receiving chemotherapy for their colon cancer noted improvement in their vision.  They must have had wet macular degeneration at the same time!

Genentech researchers were aware that anti-VEGF treatments may also be effective for macular degeneration and developed Lucentis.  They were successful in gaining FDA approval for Lucentis and the treatment of wet ARMD (macular degeneration).

The Lucentis pricing structure bothered most  physicians.  Basically, it is very expensive for both docs and patients.  Many doctors lost money using Lucentis and the patient responsibility is costly.  Lucentis is priced at about $1950 per dose.  Avastin is anywhere from $25 – $50 per dose.

The alternative became Avastin.

Avastin is also used “off-label” for the treatment of diabetic macular edema and proliferative diabetic retinopathy.  This is not unique to Avastin, but is true for the other anti-VEGF medications; Lucentis and Macugen.

What Does This Mean? Avastin is a great alternative.  Its use is well accepted in our community.  I believe Avastin is at least as effective as Lucentis. Several studies support this.  What is more interesting is that diabetic macular edema, wet macular degeneration and cancer all require VEGF!  The common denominator?……………….blood vessels.

“Randy”

Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Fairfax Virginia

Comments
  • Neil December 18, 2009 at 4:42 am

    Good post. Can you talk about what a typical course of treatment entails? Also how about a future post on presumed ocular hystoplasmosis?
    Thanks,
    Neil

    • Randall V. Wong, M.D. December 18, 2009 at 4:53 am

      Neil,

      Will try and address your first question this morning. If I don’t answer your question, please let me know.

      Regarding ocular histoplasmosis, I wrote and short blurb on OHS. Will try and get one up in the next few weeks?

      Thanks for commenting.

      Randy

  • Dick Marquis December 22, 2009 at 11:33 am

    I’m taking 4 tabs daily of Bausch/Lomb PreserVision. Bottle says nothing about Lutein content but lists Vitamins A, C, E, zinc and copper as ingredients.
    Is this the right stuff to be taking for wet ARMD or is there something better?
    Thanks

  • Randall V. Wong, M.D. December 23, 2009 at 8:37 pm

    I think this is the right formulation for you. I would caution other readers thinking that everyone with ARMD should be taking AREDS vitamins.

    Thanks for the comment!

    Randy

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