Avastin and Lucentis for Macular Degeneration, Which is Better?
It’s been a two-year, head-to-head contest—specifically, the Comparison of AMD Treatments Trials--between two often-prescribed drugs to treat age-related macular degeneration (AMD): Avastin (bevacizumab) and Lucentis (ranibizumab). Now the results are in, so which one is better?
And the winner is…
Both Avastin and Lucentis have been used by physicians to treat macular degeneration, and although the drugs work in the same way, Avastin is used more often. The CATT was the first time Avastin and Lucentis had been compared directly for treatment of AMD, and it showed both drugs to be highly effective in treating this leading cause of vision loss and blindness in older Americans.
In fact, according to Paul A. Sieving, MD, PhD, director of the National Eye Institute, “Therapies for AMD require repeated treatment to prevent vision loss. Results of this clinical trial provide evidence that long-term treatment with either drug results in a robust and lasting improvement in vision.” The study results appear in the May 2012 issue of Ophthalmology
So how should healthcare consumers choose between the two drugs? Both drugs are administered via injection, so patients don’t have a choice in mode of delivery. The authors did note a slight difference in the results associated with when the drugs were administered.
The study compared Avastin and Lucentis using monthly dosing and as-needed dosing. At two years, monthly dosing was associated with slightly better visual acuity than did as-needed dosing, regardless of the drug.
That said, visual acuity was impressive in both groups. Maureen Maguire, PhD, the study’s principal investigator, called the improvement in vision associated with these two drugs “extraordinary,” and explained that “At two years, two-thirds of patients had driving vision (20/40 vision or better). With previous treatments, only 15 percent of patients retained similar visual acuity.”
In the study, as-needed dosing resulted in 10 fewer eye injections over the two-year period, which translated into lower cost and risk compared with monthly injections. As long as the subject of cost has come up, there is a significant price difference between the two drugs.
A closer look at Avastin and Lucentis
Avastin costs approximately $50 per injection, while Lucentis is priced about $2,000 per injection. While Lucentis has been approved by the Food and Drug Administration (FDA) for treatment of wet macular degeneration, Avastin has FDA approval for colorectal cancer, but treatment of AMD is a popular off-label use.
It should be noted that Genentech is the maker of both drugs. The company originally developed Avastin to prevent angiogenesis, which is the growth of blood vessels that enable cancerous tumors to develop and spread. Genentech later developed Lucentis, which is derived from a protein similar to Avastin, specifically for AMD.
Before Lucentis was approved by the FDA in 2006, some ophthalmologists began using low doses of Avastin in their patients with macular degeneration because it was so similar to Lucentis. As more and more doctors witnessed success with the off-label use of Avastin, they kept using it, and the rest, as they say, is history.
Participants in CATT were older (average age, 80), so side effects are always of special concern in an elderly population. Side effects associated with Avastin and Lucentis were similar: a 40% rate in Avastin patients and a 32% rate in those receiving Lucentis.
The study’s authors noted that their study did not allow them to identify if there was an association between any specific side effect and treatment. They did observe that the occurrence of deaths, stroke, and heart attack was low and similar for both drugs.
Age related macular degeneration affects approximately 20 to 25 million people around the world, and occurs in two forms: wet and dry. Wet AMD is the more serious of the two, and it affects 10% to 15% of people with the disease. It is also the form treated in CATT.
Other ways to manage macular degeneration
In addition to drugs, other treatment options for macular degeneration include various nutritional supports. A study from the National Eye Institute in 2009 reported that omega-3 fatty acids added to the diet may help prevent development of the eye disease vision loss by more than 30%.
The National Eye Institute’s Age-Related Eye Disease Study (AREDS) results led its authors to recommend certain nutrients be taken in high doses to reduce the risk of AMD progressing from intermediate dry to advanced or wet disease. Those nutrients include vitamin C (500 mg), vitamin E (400 IU), beta-carotene (15 mg), zinc (80 mg), and copper as cupric oxide (2 mg).
Although there is not yet a cure for macular degeneration, individuals have options for preventive measures and treatment. Results of CATT indicate Avastin and Lucentis provide similar, effective results, although cost issues may be a factor.
National Eye Institute
Image: Wikimedia Commons