The hard data on Lucentis and Avastin is out. According to a New England Journal of Medicine study, Avastin is just as effective as Lucentis at treating macular degeneration. Avastin does have more side effects--namely an increased risk of hospitalization--but deaths, heart attacks and strokes happened at the same rate among both patient groups.
Doctors have clinical data to support choosing Avastin as a macular degeneration treatment, says study author Daniel Martin of the Cleveland Clinic, the Wall Street Journal reports. "[T]he two drugs were virtually identical," effectiveness-wise, Martin said. "[B]oth are viable options and clinicians may choose one or another." Furthermore, "health-care providers and payors worldwide will now have to justify the cost" of choosing Lucentis instead, University of Miami retina specialist Philip Rosenfeld wrote in an accompanying editorial.
But the debate over safety is likely to continue. Rosenfeld said the study wasn't large enough to clear questions about Avastin's potential side effects, Reuters reports. And Novartis development chief Trevor Mundel points out that another study comparing the two drugs--based on data from 78,000 Medicare patients--is coming over the next several days, and it shows higher risks of serious side effects in Avastin users versus Lucentis users.
"People who are really evangelical Avastin users will probably continue on their way," Mundel told Reuters, "but I think when people really think about the [NEJM] article, they will have a lot of unanswered safety concerns." Roche's Genentech markets Lucentis in the U.S., but Novartis sells it in Europe.
The worry for these companies, of course, is that clinicians will continue to use Avastin off-label for macular degeneration--perhaps in increasing numbers. If the two drugs prove equally effective, and doctors are satisfied that Avastin's side effects aren't a big deterrent, then cost could well push them toward the cancer drug, which goes for about $50 per injection, rather than Lucentis, which costs $2,000 per treatment.