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Far Less Costly Than Lucentis, Avastin Saves Sight

Study Shows Avastin Helps AMD, but Is It as Good as Lucentis?
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There are six such trials under way. The U.S. trial, funded by the NIH, is furthest along. Results are expected in early to mid-2011.

"Until then, clinicians have already decided which drug they prefer in the U.S., " researcher Philip J. Rosenfeld, MD, PhD, professor of ophthalmology at the University of Miami's Bascom Palmer Eye Institute, tells WebMD via email. Rosenfeld has conducted clinical trials of Lucentis and also has pioneered the use of Avastin for AMD.

Some doctors, Rosenfeld says, use Lucentis because they can recover 6% of the average sales price if they sell the drug to their patients. Others prefer Avastin because they are at less risk if a patient's insurance company refuses reimbursement. Genentech, he notes, is in no hurry to get Avastin approved because the company makes nearly $1 billion a year on Lucentis sales in the U.S. alone.

Financial incentives, of course, are a poor way to decide which drug to use. There's reason to believe that Lucentis works better, because molecule for molecule, it's a stronger inhibitor of VEGF than is Avastin. But there's also reason to think Avastin works better: It's a larger molecule that may linger longer in the eye, reducing the number of uncomfortable injections needed each year.

In past interviews, retina specialists have told WebMD that some patients do better on Avastin, while others do better on Lucentis.

In all cases, however, the treatment only works for patients treated in the first year wet AMD develops. In later stages of AMD, there is irreversible damage to the retina.

It's also not clear how often patients need Avastin or Lucentis injections. Some patients appear to require monthly injections, while others need no more than two a year.

The Tufail study, and the Chakravarthy editorial, appear in the June 11 online edition of BMJ. Rosenfeld has received study grants and speakers fees from Genentech and/or other pharmaceutical companies. He has publicly argued that the cost of Lucentis is too high.

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