Avastin vs Lucentis: Two Drugs, One Treatment for Macular Degeneration

Avastin and Lucentis are two anti-VEGF drugs with almost the exact same molecular make-up and both have been used to treat wet macular degeneration.  The similarities in both Avastin and Lucentis has many experts asking questions.

Off-label drug use is the practice of prescribing a drug for outside the use they were approved for.  Any approved drug may be used by a licensed practioner for uses other than those stated on the label.  The physician must make decisions based on best judgement and what they have learned about the drugs through medical journals and their colleagues.

With Avastin and Lucentis, the practice of off-label prescribing has a totally different meaning and has fueled the debate.

In 2006, Lucentis (ranibizamab) was approved by the U.S. Food and Drug Adminstration (FDA) as a treatment for wet macular degeneration.  Many doctors have argued however, that Avastin (bevacizumab) is as effective as a treatment of wet macular degeneration and it costs considerably less than Lucentis.  Avastin is only approved as a cancer drug and not as an FDA approved treatment for wet macular degeneration.  Those physicians prescribing this as a treatment for macular degeneration have been prescribing Avastin as an off-label use.

With Avastin and Lucentis, things are not always as they appear.  This is more than a simple case of off-label prescribing.  Both Avastin and Lucentis are produced by the same pharmaceutical company, Genentech.  Lucentis is a direct derivative from the original drug Avastin, with both being almost identical in molecular makeup.

In October 2007, Genentech announced it would limit the supply of Avastin for ocular uses starting January 1, 2008.  This announcement led to many outcries from the ophthalmology community, especially since it was felt that Genentech was putting profits ahead of patient care largely because Lucentis costs approximately $2,000 per treatment and Avastin costs appproximately $100 – $150 per treatment.  This is compounded by the fact that experts cannot determine the difference in eyes treated with Avastin and eyes treated with Lucentis when both drugs are used to treat macular degeneration.

This has placed many governments in a situation where they must either decide to provide coverage for the more costly drugs or allow the less expensive drug to be used to treat wet macular degeneration.  Add  to this the pressures that regulating bodies such as the Common Drug Review committee in Canada places on governments by recommending that the provincial health care systems in Canada should provide coverage for Lucentis.  Now countries with publicly funded health care systems such as Canada and the UK must make a decision as to whether they will provide the expensive drug Lucentis or balance their costs by allowing physicians to continue to use the off-label Avastin.  Governments are concerned with the liabilities that this may pose on them and the physicians, but must strike a fine balance between being fiscally responsible or meeting legally mandated requirements to provide free health care.

The fact that Lucentis costs much more than Avastin has not gone unnoticed.  In the United States the Senate Special Committee on Aging had contemplated holding hearings surrounding this controversy of Genentech’s pricing for Lucentis.  While this did not occur, Wisconsin Democrat Herb Kohl did call for an investigation into Genentech’s decision to limt the supply of Avastin if it was to be used in treating macular degeneration.

Genentech did lift the restrictions on the supply of Avastin when faced with the threat of hearings and an investigation, and promised to provide free Lucentis for an NIH/National Eye Institute sponsored head-to-head study designed to evaluate Avastin and Lucentis.

This entire controversy will continue for some time until trials and studies into these two closely related drugs continue and the findings are presented and reviewed by experts.  Until then, the controversy will continue and it is the patients and governments who pay the ultimate price, one with their vision, their other with their bottom line.

Avastin and Lucentis, two drugs to treat macular degeneration, steeped in controversy and politics.

Comments

  1. I have had 3 Lucentis treatments and so far have noticed some improvement

  2. Thanks for an excellent article! When my mother was diagnosed with wet macular degeneration four months ago I attended appointments with her. The ophthalmologist gave us the same information as contained in your article and recommended the use of Avastin. Since the Manitoba government does not cover the cost of either Avastin or Lucentis my mother obviously opted for Avastin at $100/treatment. Lucentis, at $2,000/dose, would have cost $20,000 for the prescribed course of 10 treatments. This would have been beyond our ability to pay. Considering the majority of wet macular degeneration patients are seniors on fixed incomes it is disgraceful that a company would try to make them choose between their eyesight and selling their house (if they own one).

  3. Like the previous blogger, I also am from Manitoba and have attended appointments with my mother for her wet macular degeneration treatment. We were able to get the Avastin at $75/shot, (even more discrepency in pricing). The difference, I believe, between the two drugs is a largely a matter of patents and profits.

  4. The drug company should be sued . How can they,seeing as they manufactor both drugs, and they do the same thing in treatment, charge such a difference in the price.

  5. krystie s says:

    The reason why they charge so much for Lucentis is because of the way they developed the drug. Avastin is the big molecule— Lucentis is now just a fragment of that molecule, with the same genetic makeup, only in a smaller form. The reason it is $2,000 is becuase of the steps they need to take to get that smaller molecule. It is supposed to be better at targeting the areas of blood vessel growth because of its smaller size. I work at one of the research sites conducting the studies. It is a topic of conversation all the time. It really just costs more because of the process, that’s what the patients are paying for. I’m for avastin all the way!

    • Maybe a smaller molecule costs more , or maybe the drug companies just want the biig profit from Lucentis. Remember they tried to avoid selling Avanits for eye treatment once the invented Lucentis. Only public presseure got Avantis back as an off label drug for macular degeneration

  6. Locksley Gardner says:

    At this point , having read so much on the advantages and or differences between Avastin and Lucentis, I am willing to refer to my retina specialist, who has had his share of concern for his patients.

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