The Burrill Report


The National Health Service could save $129 million a year by using Avastin instead of Lucentis as a treatment for wet age-related macular degeneration, a leading cause of blindness in older adults, according to researchers who found the two drugs equally effective at treating the eye disease.

The two-year study by researchers at Queen’s University Belfast and elsewhere in the United Kingdom, and published July 19 in The Lancet, further fuels an ongoing controversy about the use of the two drugs to treat wet AMD. Both drugs developed by Genentech are vascular endothelial growth factor, or VEGF, inhibitors. Ophthalmologists often use Avastin, which is not approved as a treatment for the disease, as an off-label treatment because it is significantly less expensive. The findings are in line with a similar National Institutes of Health study, known as the “CATT” trial, results of which were announced in April 2012.

In the United Kingdom, where Novartis markets Lucentis, the drug is the most commonly used treatment for wet AMD. It costs nearly $1,100 (£700) per injection. Avastin, which is marketed by Roche, costs about $92 (£60) per injection.

The researchers say their findings will be relevant to the next round of technology appraisals by the National Institute for Health and Care Excellence and could lead to important changes to the way wet AMD is treated.

In the study dubbed “IVAN,” a total of 610 people with wet AMD participated in a two-year trial. Patients received injections into the affected eye every month for the first three months. Patients were then subdivided into two groups with one group receiving the injections at every monthly visit and the other group getting injections as needed if the specialist decided there was persistent disease activity. The “as needed” group received on average 13 injections over the two year period compared to 23 for the monthly treatment group.

The study’s two year results showed that sight was equally well preserved with either of the two drugs. It also found giving the treatment regularly every month resulted in slightly better levels of sight, detected through testing of near visual acuity and contrast sensitivity. The researchers, though, noted continuous treatment caused a higher proportion of eyes to develop a condition known as geographic atrophy, which is a thinning of the retina and its blood supply.

The IVAN study also found serious adverse events were similar for the two drugs. Deaths, however, occurred less frequently in the group that received monthly treatment. When these safety results were combined with the CATT trial in the United States, the researchers say the findings continued to indicate fewer deaths when treatment was given monthly.

The researchers say for an older person starting a course of either drug, it will be important to explain the trade-off between the number of injections and the chances of developing geographic atrophy and risk of mortality in two years.

In a comment accompanying the study, Chui Ming Gemmy Cheung and Tien Y Wong of the Singapore Eye Research Institute at the Singapore National Eye Centre, note that a limitation of the researchers’ analysis is that they used only one-year data from the CATT study. The comment notes that because of the small number of adverse events in the CATT study at one year compared to two years, the IVAN study is unclear at answering the question of safety differences between the two treatments. As a result, it says Lucentis users are unlikely to switch to Avastin and “policymakers are unlikely to mandate such a switch.”


July 19, 2013
http://www.burrillreport.com/article-avastin_as_good_as_lucentis_for_wet_amd_at_a_tenth_of_the_price.html