Unusual dilemma for Genentech: Competing against itself

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The results from a multicenter trial funded by the National Eye Institute (part of the National Institutes of Health) demonstrate that after one year of follow-up, both Lucentis (ranibizumab) and Avastin (bevacizumab) had equivalent effects on maintaining or improving visual acuity in the treatment of wet age-related macular degeneration (AMD), a common cause of irreversible blindness among the elderly. Interestingly, Genentech, a unit of Roche Holding AG, manufactures both drugs. But while Lucentis is FDA-approved for this condition, Avastin is a cancer drug used off-label for the treatment of AMD, which the company states is risky. The new study, however, challenges that assertion.

In the study, published in the New England Journal of Medicine, researchers randomly assigned 1,208 patients with wet AMD to receive injections of either Lucentis or Avastin directly into the vitreous portion of the eye on either a monthly schedule or as needed and found that both drugs resulted in the same outcome. The difference is — and it’s a large one — that Lucentis costs $2,000 per treatment, while Avastin is only $50 per injection. Both drugs are inhibitors of vascular endothelial growth factor (VEGF) — they work by inhibiting blood vessel growth — the cause of wet AMD.

The study researchers did not note any difference in the number of adverse health effects between the two drugs, but results from the second year of the CATT study will further clarify these findings.

“I see no reason in the world why the cheaper Avastin drug should not become standard-of-care for wet AMD unless follow-up confirms some increased safety concern with Avastin,” adds ACSH's Dr. Gilbert Ross. “It seems to be markedly less expensive yet yields the same results as Lucentis from an efficacy point of view.”