Avastin Versus Lucentis; And the Winner Is…

Both Avastin and Lucentis are anti-VEGF treatments for wet macular degeneration. Both are manufactured by Genentech (Roche). A small study just (February 2010, Ophthalmology) published found no clinical difference between the two drugs, that is, one worked as well as the other.

There has been quite a debate over the difference between the two drugs and their ability to treat wet macular degeneration. There are differences in cost, FDA approval, etc., but this is the first study that has compared the two drugs head to head.

The large difference in cost between the two drugs has led to speculation that the popular use of Avastin among retina specialists is due to price alone. The chemotherapy agent costs less than $50 per injection whereas Lucentis is priced at $2000 per injection. Supporters of Avastin (including yours truly) feel that its use is justified by the excellent results and in many areas of the country has become the standard of care.

Other than price there are differences in the number of isoforms that the molecules block; Avastin blocks more isoforms than Lucentis, but is this significant in the eye? No one knows. It seems not to matter.

What Does this Mean? This study was a retrospective study, that is, the results were determined looking backwards. One weakness of retrospective studies is that there are too many variables between patient groups to allow a true “head to head” comparison. The result, too much bias in the study and it is difficult to make true, concrete conclusions. It doesn’t mean that retrospective studies are worthless, but you must keep in mind there may be flaws in the conclusions.

A prospective, randomized study is really the gold standard. In these studies, similar patients (similar in age, vision, race, etc.) are treated exactly the same and differ only in the treatments they receive. In this case, similar patients would be randomly treated with either Avastin or Lucentis. The patients are treated with the exact same protocol with respect to dosage, frequency of injection, etc. The groups are then followed for a given length of time.

The results of prospective studies have far less bias and results are taken to be more meaningful. An NIH sponsored prospective study is underway comparing Avastin vs. Lucentis and may be completed by 2011.

This “study” also gives both patients and doctors reassurance that the use of Avastin is justified.

For now, there seems to be no advantage to using either drug.

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Randall V. Wong, M.D.

Ophthalmologist, Retina Specialist
Fairfax, Virginia

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