Avastin and Lucentis: Neck and Neck

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Avastin and Lucentis: Neck and Neck

A retrospective study finds that Avastin is as effective in the treatment of wet macular degeneration as its counterpart, Lucentis. The study also found that fewer Avastin were required compared to Lucentis. Other differences were noted.

Both Avastin and Lucentis are anti-VEGF treatments for wet macular degeneration.  Both are manufactured by Genentech (Roche).  A small study just published found no clinical difference between the two drugs, that is, one worked as well as the other.

There has been quite a debate over the difference between the two drugs and their ability to treat wet macular degeneration.  There are differences in cost, FDA approval, etc., but this is the first study that has compared the two drugs head to head.

The large difference in cost between the two drugs has led to speculation that the popular use of Avastin among retina specialists is due to price alone.  Avastin costs less than $50 per injection whereas Lucentis is priced at $2000 per injection.  Supporters of Avastin (including yours truly) feel that the use of Avastin is justified by the excellent results.

Other than price there are differences in the number of isoforms that the molecules block; Avastin blocks more isoforms than Lucentis, but is this significant in the eye?  No one knows.  It seems not to matter.

What Does this Mean? This study was a retrospective study, that is, the results were determined looking backwards.  One weakness of retrospective studies is that there are too many variables between patient groups to allow a true “head to head” comparison.  The result, too much bias in the study and it is difficult to make ture, concrete conclusions.  It doesn’t mean that retrospective studies are worthless, but you must keep in mind there may be flaws in the conclusions.

A prospective, randomized study is really the gold standard.  In these studies, similar patients (similar in age, vision, race, etc.) are treated exactly the same and differ only in the treatments they receive.  In this case, similar patients would be randomly treated with either Avastin or Lucentis.  The patients are treated with the exact same protocol with respect to dosage, frequency of injection, etc.  The groups are then followed for a given length of time.

The results of prospective studies have far less bias and results are taken to be more meaningful.  An NIH sponsored prospective study is underway comparing Avastin vs. Lucentis.

For now, there seems to be no clinical advantage to either drug.

“Randy”

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

Comments
  • Marion January 11, 2011 at 2:01 pm

    I HAVE BEEN ON AVASTIN ON AND OFF FOR OVER A YEAR…MY EYE HAS GOTTEN WORSE SO MY DR. DECIDED TO CHANGE TO LUCENTIS…HE FEELS MY EYE HAS BECOME RESISTEND TO AVASTIN….MY SITE IN THAT EYE IS 20/200 WITH GLASSES…HOPEFULLY IN FEB WHEN I RECEIVE THE NEW SHOT IT WILL GET BETTER…WHATDO YOU THINK?

    • Randall V. Wong, M.D. January 17, 2011 at 9:47 pm

      Dear Marion,

      I don’t see the harm in changing to Lucentis, especially if it seems as though you aren’t gaining any ground. I’d probably recommend the same if you were my patient. The only way to tell if you may get better is via fluorescein angiogram and/or OCT looking for retinal edema.

      I hope it works. Please keep us all posted!

      Randy

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