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Macular Degeneration Drug Adds Vision

Lucentis Prevents Vision Loss, Restores Vision for Many
By
WebMD Health News
Reviewed by Louise Chang, MD

Oct. 4, 2006 -- Lucentis, a newly approved drug for age-related macular degeneration, not only prevents blindness but actually improves many patients' vision.

Macular degeneration is the leading cause of blindness in people aged 50 and older. The major finding comes from two clinical trials reported in the Oct. 5 issue of The New England Journal of Medicine.

David M. Brown, MD, a retina surgeon at Houston's Methodist Hospital, was a researcher for one study. Philip J. Rosenfeld MD, PhD, of the University of Miami's Bascom Palmer Eye Institute, was a researcher for the other.

"It is truly better than our greatest expectations," Brown tells WebMD. "The biggest advance from both trials is they are the first ever to show significant improvement in vision."

"This is not a cure," Rosenfeld tells WebMD. "If macular degeneration patients have lost vision for a year or longer, this is not going to restore their vision. But for the right patients, at the right point in their disease, these drugs are extremely beneficial."

Lucentis is expensive. The wholesale cost is $2,000 a dose. But Brown says there are different ways to look at this cost.

"I have a patient, a farmer with one eye, who was 96 when he started the study and is 99 now -- still driving his tractor and still taking care of his cows," Brown says. "They talk about the cost of this drug. But the cost of not being able to drive and losing your job and being put in assisted living -- that is the true cost."

Lucentis and Avastin

While the Brown and Rosenfeld studies focused on Lucentis, they have implications for a drug that wasn't being tested: Avastin.

Lucentis, made by Genentech, is an offshoot of Avastin, a cancerdrug also made by Genentech. Lucentis is 100 times more expensive than Avastin.

Lucentis and Avastin work by exactly the same mechanism. Both are antibody-based drugs that block the chemical messenger -- vascular endothelial growth factor A or VEGF-A -- that tells new blood vessels to grow.

In cancer, Avastin keeps tumors from growing the blood vessels they need to survive. In wet macular degeneration, Lucentis stops the inappropriate growth of blood vessels that leak fluid and displace the retina.

Avastin is a whole anti-VEGF antibody, designed for infusion into the bloodstream. Lucentis is the active fragment of the antibody, specifically formulated for injection into the eye. Before Lucentis became available, Rosenfeld and others pioneered the use of eye injections of Avastin to treat wet macular degeneration.

"I have examples where some patients respond better to Avastin and some respond better to Lucentis. Not everyone is the same," Rosenfeld says. "We wonder if Avastin is safe if used long term. And is it as effective as Lucentis? This week we learned the National Eye Institute has funded a study to compare the two, so we will have a multicenter trial to compare the two drugs."

Still, the cost of Lucentis contributes to worries about the rising cost of health care.

"Eighty-one percent of patients eligible for Lucentis treatment have enough insurance -- Medicare supplemental insurance or private insurance -- to bring their copay down to $50 or less," Genentech spokeswoman Dawn Kalmar tells WebMD. "About 3% of patients are uninsured. They are good candidates for our free drug program. We are committed to all patients having access to our drugs, regardless of their ability to pay."

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