The controversy over whether Avastin can replace Lucentis as a treatment for wet AMD has intensified following the publication of a major clinical study.
The CATT study, a head-to-head comparison of the two injectable drugs, suggests that Avastin is comparable to the more expensive Lucentis in terms of clinical efficacy.
However, the study also highlights that Avastin may increase the risk of major adverse events such as blood clots and congestive heart failure.
Roche’s Avastin (bevacizumab) is not licensed for treatment of the eye disorder wet AMD, which affects many elderly people, in Europe or the USA.
However, its off-label use has become widespread because it is much cheaper than the standard treatment, Roche’s Lucentis (ranibizumab) – which is marketed outside the US by Novartis.
In the UK, Lucentis (which costs £890 per dose) is the only NICE-approved treatment for wet AMD, but some PCTs recommend the use of Avastin (at £50–100 per dose) to save money.
Novartis is currently seeking a judicial review of the recommendation of Avastin for wet AMD by one PCT cluster.
The two-year Comparison of Age-related macular degeneration Treatment Trials (CATT), carried out by the National Eye Institute in the US, has concluded that both drugs offer “robust and lasting” improvements in vision.
However, those patients taking Avastin show a higher incidence of serious adverse events (40%) than those taking Lucentis (32%). The high figures reflect the median age (over 80) of the study participants.
The adverse events recorded include arterial and venous blood clots, haemorrhagic stroke, congestive heart failure and vascular death
The study authors concluded: “The choice of drug and dosing regimen for patients must balance the comparable effects on vision, the possibility of true differences in adverse events, and the fortyfold difference in cost per dose.”
However, Novartis has drawn attention to the adverse event data, arguing that “it would be inappropriate to advocate use of unlicensed bevacizumab for wet AMD, on the basis of these trials,” and further noting that of the two drugs, only Lucentis was specifically designed for use in the eye.