The debate on Lucentis and Avastin

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For those 200,000 age-related macular degeneration (AMD) patients in an average year in U.S., the most effective treatment that has been approved by FDA is Lucentis. This drug brings hope to wet form AMD patients by stopping and sometimes reversing vision loss, which is a huge breakthrough. Yet another medication similar to Lucentis is also under wide discussion. It is formally called Avastin. One point is true that Avastin is much cheaper than Lucentis, so that many doctors recommend Avastin for low-income patients.

The sale of Avastin should not be restricted

However, Avastin has not received FDA approval for ophthalmic uses. Based on safety issues, Genentech Corporation also restricts the sale of Avastin to compounding pharmacies for ocular uses. Both Lucentis and Avastin are owned by this company. Since the FDA has expressed no concern about Avastin’s off-label uses for AMD, many eye doctors argue that Genentech should allow Avastin to be directly sold to both physicians and compounding pharmacies. If only physicians have access to Avastin, doctors at the American Academy of Ophthalmology protest that many lower income people will be deprived of this sight-saving drug. The fact is that Lucentis costs an average of $2,000, while Avastin charges only $150.

A huge price discrepancy marks the biggest difference

During the wide off-label uses of Avastin, this treatment has not been proved to be as effective as Lucentis, or even more effective. No clinical study has made a comparison between the two AMD treatments. The most common concern is their price discrepancy. Even if Medicare and other health insurance plans offset parts of the Lucentis expense, it is still much more expensive than Avastin. For example, patients with Medicare may only need to pay a 20% of co-payment for Lucentis, which equals about $400.

An policy explanation from Genentech

Genentech has given an explanation about its different policies on these two drugs. Genentech officials say that the high price of Lucentis comes from its special development and its considerable expense of clinical trials. Lucentis is administered in the form of smaller molecules, which are more effective in controlling abnormal blood vessels. The company also claims that they will not conduct new trials for Avastin, since Lucentis has already got FDA approval and is a promising AMD solution. The good news may be that the U.S. government is likely to fund the comparison between Lucentis and Avastin.

Safety concern about Avastin’s use for AMD

While the initial use of Avastin for colon and other cancers was reported to arouse risks of developing stroke and heart attack, its use for macular degeneration has brought no negative side effects. Most of the doctors are positive about Avastin’s long-term safety. Due to its low price, researchers encourage the use of Avastin. There are also concerns that Avastin may be unable to penetrate the eye’s retina effectively. The undergoing two-year NEI clinical trial may settle down all these controversies.

Who are not eligible for Avastin?

Even if Avastin has not yet been approved for AMD treatment by FDA, it has received wide application in other fields against some other diseases, such as metastatic colorectal cancer, non-small cell lung cancer and metastatic kidney cancer. Its application for treating these conditions is strictly restricted against some groups of people. For instance, pregnant women, breast-feeding ladies, people undergoing surgery and those under the age of 18 are bad candidates for Avastin.