Avastin, Lucentis equally effective at improving vision, big study finds

More fuel for the Avastin-vs-Lucentis debate: A big U.S. government study of the two drugs deemed them more or less equivalent for treating age-related macular degeneration. It's a finding that could be good news for government payers and insurers, but not so good for sales of the much more expensive Lucentis.

For several years now, doctors have been using Roche's ($RHHBY) Avastin off-label to treat wet AMD. The cancer drug, when repackaged in doses small enough for eye injections, costs only about $50 per dose. Lucentis, which Roche developed specifically for eye use, costs about $1,950 per dose. And because it's the FDA-approved choice, Lucentis has a lot of takers; as The Wall Street Journal points out, Lucentis was the single biggest expenditure in Medicare's Part B program covering injectable drugs.

Not surprisingly, Roche hasn't been happy to see its cancer drug cannibalize any sales from its purpose-built Lucentis. Its U.S. unit, Genentech, tried to restrict distribution of Avastin to preclude ophthalmic use, but eye doctors revolted, and the restrictions were softened.

And just last week, Novartis ($NVS)--which markets Lucentis outside the U.S.--asked for judicial review of off-label Avastin use in the U.K., where Lucentis is approved by regulators for AMD treatment. (It's also approved by the cost-effectiveness watchdogs at the U.K.'s National Institute for Health and Clinical Excellence, but NICE can't consider Avastin for the same use, because it doesn't have regulatory clearance for that use.)

Medicare could save a lot of money, obviously, by using Avastin instead of Lucentis. So, the National Eye Institute--part of the National Institutes of Health--embarked on this study. The two-year results hit the journal Ophthalmology yesterday, and an NEI official said both drugs delivered "robust and lasting" improvements in vision. There was a slight difference in side effects--serious adverse events affected 40% of Avastin patients and 32% of those using Lucentis--but as the WSJ points out, the study participants were elderly, with a median age of 80-plus, and as such more prone to health problems.

Bottom line? "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," the researchers wrote (as quoted by the WSJ). We'll see how the payers respond.

- read the WSJ coverage