April 4, 2011 -- One drug costs $50 per dose. The other costs $2,000 per dose. Now, new research shows that the drug Avastin, normally used in cancer treatment, is just about as effective at treating an eye disease that can lead to blindness as the more commonly used and more expensive Lucentis.
Full publication of results from the head-to-head study of Avastin (bevacizumab) and Lucentis (ranibizumab) in "wet" age-related macular degeneration (AMD) confirmed information previously leaked to the media -- that the two drugs differed little in preserving vision.
Patients receiving monthly doses of Avastin gained 8.0 letters of visual acuity after one year, compared with an 8.5-letter gain for those receiving Lucentis, according to the study, published online ahead of schedule in the New England Journal of Medicine.
The 1,161-patient trial was sponsored by the National Eye Institute and carried out by the Comparison of AMD Treatment Trials (CATT) research group, with Maureen G. Maguire of the University of Pennsylvania in Philadelphia, as corresponding author.
The results have been much anticipated in the ophthalmology community because of the huge cost difference between the two drugs. A dose of Avastin -- used off-label for this purpose, as the drug is currently approved only for cancer indications -- costs about $50 whereas a dose of Ludentis, which is approved for AMD, costs about $2,000.
Both drugs are made by Genentech, which has been understandably reluctant to fund a head-to-head trial that could undercut the market for the more expensive drug.
Consequently, the National Eye Institute stepped in to fund the CATT study.
The findings were originally to be released in a presentation at the Association for Research in Vision and Ophthalmology (ARVO) meeting this Sunday, with a simultaneous online publication in NEJM. But the New York Times persuaded some anonymous trial investigators to provide top-line results, which the newspaper posted on its website Wednesday.
The NEJM paper by Maguire and colleagues was then hastily published online Thursday morning.
By far the largest difference between the two drugs was in cost. Maguire and colleagues reported that Avastin delivered monthly cost an average of $595 and Lucentis cost $23,400.
If the drugs were taken only as needed, rather than on a monthly basis, the cost dropped for both drugs, but Avastin was still the bargain choice: $385 for the year of treatment compared with $13,800.
Genentech had no immediate comment on the study results.
In an editorial accompanying the NEJM paper, Dr. Philip J. Rosenfeld said the findings would probably not end debate over which drug is most appropriate. Rosenfeld also suggested that Avastin may have "a less durable treatment effect" in at least some patients, such that more frequent dosing may be needed.