Avastin and Lucentis equivalent for treatment of AMD

[06/05/2012]

Avastin and Lucentis equivalent for treatment of AMD



In the ongoing "dogfight" between Avastin and Lucentis, more data has come out confirming the equivalence of the 2 drugs in the treatment of age related macular degeneration.

Just to recap --> age related macular degeneration (AMD) is the leading cause of blindness in developed nations and the treatment for this disease was revolutionized with the introduction of intravitreal anti-VEGFs in 2004. Macugen was the first approved treatment to hit the market but it's results were modest. Avastin came along in 2005 but was used "off label" as it was only approved for treatment of metastatic colon cancer. Subsequently, it's counterpart Lucentis was approved for treatment of AMD in 2006 and these 2 drugs have been the mainstay of AMD treatment since then. Treatment requires monthly injections to maintain vision as according to the landmark studies on Lucentis.

The "dilemma" arises because Avastin costs US$50 per injection whereas Lucentis costs US$2000 - the economic burden (for the patient as well as for healthcare authorities) is mainly responsible for the undertaking of the Comparison of Age related macular degeneration Treatment Trials (CATT) study to put these two drugs into a head to head comparison. This trial was designed to look at the outcomes of treatment with the 2 different drugs either with monthly injections or as needed injections. The 2 year results have only just been published in an ophthalmology journal a few days ago. (http://www.ophsource.org/webfiles/images/journals/ophtha/announcement.pdf)

What is the outcome?

The 2 year results shows that Avastin and Lucentis are equivalent in terms of their effectiveness in treating age related macular degeneration. Summary of the findings are as below:-

1) Gain in vision was similar in both groups at 2 years.

2) Treatment instituted every month (with either drug) gave better outcomes when compared to treatment given as needed.

3) The rates of strokes or death in the 2 groups were similar. However, Avastin had a higher rate of systemic serious adverse events compared to Lucentis (40% vs 32%). Examples of adverse events include hypertension, infection, stroke, cardiac disorders, gastrointestinal disorders.

What it all means?

This does not change the practice of retinal surgeons very much as the effectiveness and significant cost saving with Avastin will factor into the decision making process when discussing with the patient about treatment options. However, it is important that the potentially increased risk of systemic problems (particularly gastrointestinal) be fully disclosed to the patient.

When cost is not an issue, Lucentis still prevails but there is a "new kid on the block". Eylea (VEGF Trap) which is priced at US$1850 per injection and is approved for treatment every 2 months rather than monthly, has been proven to be equivalent to Lucentis as well. This would be an attractive option to both patient and surgeon as there will be fewer injections required. It is however, not yet available in my part of the world.