Wednesday, May 14, 2008

Market trends: cancer vs. ophthalmology drugs

Today I was at the ophthalmologists office getting my eyes tested for some new glasses. The technician and I were chatting convivially about the pros and cons of Avastin versus Lucentis for wet age-related macular degeneration (AMD).

Later, while looking at the National Institutes of Health (NIH) site on the internet, I noticed they have finally started an independent trial that is designed to show how the two drugs stack up against each other. Both inhibit Vascular Endothelial Growth Factor (VEGF) but have different approved uses and indications.

Lucentis has been FDA-approved for use against wet AMD. Avastin isn't,it's approved for treatment of cancers such as colorectal carcinoma. Ophthalmologists and retinal surgeons have, however, commonly used it off-label, saying it's almost as effective as Lucentis, if not as effective. And Avastin also costs much less, i.e. $50 rather than $2,000. The challenge was that Avastin needed to be compounded by pharmacies and last year Genentech moved to restrict sales of Avastin to those pharmacies who were compounding Avastin for ophthalmology use, stating that there was a risk of microbial contamination from compounding and the FDA were concerned about the re-packaging.

The NIH decided to take matters into its own hands and perform a trial to answer the question. Time will tell. If the trial shows no difference between the two, expect Avastin to cannibalise sales of Lucentis and insurers/payers to exert their muscle in favour of the cheaper alternative.

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