Avastin vs Lucentis

Avastin vs Lucentis:

When faced with a huge disparity in price, what treatment would be preferable for of Wet ARMD in the Avastin vs Lucentis debate?

Wet ARMD is the more visually debilitating type of ARMD and is characterized by the formation of Choroidal Neovascularization, which is formation of new, fragile blood vessels under the Retina. These fragile vessels can leak or bleed and thus cause central vision loss.

A growing body of evidence suggests that Vascular Endothelial Growth Factor (VEGF) plays an important role in the development of Neovascularization and the vessel leakage that leads to central vision loss.

Both Avastin®, a full-length humanized monoclonal antibody against VEGF, and Lucentis®, a humanized, monoclonal antigen-binding fragment against VEGF, are able to bind and inhibit all isoforms of VEGF. So what factors need to be considered in the Avastin vs Lucentis debate?

The ongoing Avastin® vs. Lucentis® debate The case for Lucentis®

  • Although Lucentis® has one binding site for VEGF compared to the two that Avastin® has, Lucentis® has been affinity matured, exhibiting 3-to 6-fold higher affinity for VEGF than Avastin®. The smaller molecule size is designed for better retinal penetration.
  • Not only is Lucentis® FDA approved, but it is favored by Medicare. Medicare’s special reimbursement code introduced at the end of 2009 for the smaller doses of Avastin® for use in the eye resulted in a Medicare reimbursement of about $7.20 per dose.
  • This new policy will financially incentivize ophthalmologists to choose Lucentis®, which would not cost them anything because they’ll be reimbursed in full.
  • The new reimbursement for Avastin® means that ophthalmologists would lose money using it since they would be charging a third of what they pay, which is about $30 to $50 per injection.
  • Another disadvantage of Avastin® is the lack of long term, randomized, prospective and placebo-controlled clinical trials. These studies will be instrumental in optimizing the selection of patients who are likely to profit most from intravitreal Avastin® injections and to improve visual outcome in the long term.

The case for Avastin®

  • Avastin® is closely related to Lucentis®, differing in that it is a full-length humanized Anti-VEGF monoclonal antibody, whereas Lucentis® is an antigen binding fragment.
  • Avastin® appears to require fewer treatments, perhaps because it is a larger molecule than Lucentis® and likely clears the eye more slowly.
  • Many ophthalmologists have expressed a preference for Avastin® partly because it appears comparable to Lucentis® in safety and efficacy while it costs the patient and society much less.
  • Although Medicare’s new reimbursement code for Avastin® means lost money for ophthalmologists while Lucentis® use will be reimbursed fully to the doctor, individual patients will pay more with Lucentis® use. The typical 20% co-pay for Medicare with Lucentis® use means you can pay a bill of about $400.00.

The off-label use of intravitreal injections of Avastin® for Wet ARMD has occurred since May 2005. Because of remarkably good results, Avastin® use expanded quickly. Examples of good results found included:

  • An early, nonrandomized trial of Avastin® in patients with Wet ARMD showed highly significant improvement in vision at 4 and 8 weeks following intravitreal injection.
  • Several small, randomized controlled trials subsequently showed that intravitreal injection of Avastin® was more efficacious than PDT in improving vision and the incidence of adverse effects was low.

The Avastin vs Lucentis debate may be settled in 2012, with the results of the Comparison of Age-Related Macular Degeneration Treatment Trials (CATT), the first large-scale, head-to head comparison between the two drugs for the treatment of Wet ARMD. Both as-needed dosing and continued monthly injections are being studied in this trial.


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