Avastin as Effective as Costlier Lucentis for AMD

April 29, 2011

April 29, 2011 — Bevacizumab (Avastin) works just as well as ranibizumab (Lucentis) in treating neovascular or "wet" age-related macular degeneration (AMD) while costing 20 times less, according to a study published online yesterday in the New England Journal of Medicine.

The study also found that administering either drug on an as-needed, less frequent basis is practically as effective as administering either one monthly, which creates more of a burden for elderly patients.

Both drugs are made by Genentech. Ranibizumab is approved by the US Food and Drug Administration for treating AMD, and bevacizumab is approved for various forms of cancer. The 2 drugs, molecularly similar, block blood vessel growth.

Because bevacizumab as well as ranibizumab inhibits the formation of blood vessels that cause AMD, physicians have prescribed the former drug on an off-label basis for patients with this condition and reported good results. The main impetus for resorting to an off-label solution has been economic: Ranibizumab costs approximately $2000 per dose while bevacizumab costs close to $50.

Neovascular AMD is the leading cause of legal blindness. Of the 250,000 Americans treated for AMD each year, most are injected with bevacizumab, said Paul Sieving, MD, PhD, director of the National Eye Institute of the National Institutes of Health, at a press conference yesterday.

Dr. Sieving's agency funded a 2-year clinical trial comparing the efficacy of ranibizumab and bevacizumab for neovascular AMD. The trial, which involved some 1200 participants close to age 80 years, also compared the effectiveness of monthly vs as-needed administration of both drugs.

More Research Needed on Differing Risks for Adverse Events

The results from the first year of the clinical trial show that whether they are given monthly or on an as-needed basis, ranibizumab and bevacizumab improve visual acuity to almost an equal degree — within 1 missed letter on an eye chart. In addition, as-needed ranibizumab performed as well as monthly ranibizumab. The same comparison for as-needed and monthly bevacizumab was inconclusive, but study authors nevertheless stated that "excellent results could be achieved with less-than-monthly regimens for both drugs."

The first-year results also allayed safety concerns. Rates of death, myocardial infarction, and stroke were similar for patients receiving either drug. The rate of serious adverse events, such as hospitalization, was somewhat higher for patients taking bevacizumab (24.1%) than those taking ranibizumab (19%). Lead author Daniel Martin, MD, from the Cleveland Clinic Cole Eye Institute and colleagues stated that results from the second year of the clinical trial, as well as from other studies, will shed light on the differing risks reported for serious adverse events, which may not be attributable to the drugs themselves.

Coauthor Juan Grunwald, MD, reported receiving consulting fees from GlaxoSmithKline, and coauthor Glenn Jaffe, MD, reported receiving consulting fees from Neurotech and SurModics. The remaining authors have disclosed no relevant financial relationships.

N Engl J Med. Published online April 28, 2011.