October 6, 2010

Macular Degeneration Drugs: Which is Better?

(Ivanhoe Newswire) "“ Age-related macular degeneration (AMD) is the leading cause of blindness for people over fifty. There are two treatments for AMD, although there is no cure, these treatments reduce the impact that macular degeneration has on vision. The two drugs include Bevacizumab (Avastin) and Ranibizumab (Lucentis). Scientists, for the first time, have discovered that there may not be any difference in the efficacy of these drugs- one is not better than the other.

AMD affects millions of people each year, and is ultimately inevitable. It causes central vision loss, meaning blurred vision or even vision with blank spots in it. It can influence depth perception as well. AMD occurs when the macula- the central part of the retina that is important for reading and deciphering colors- becomes damaged. There are two forms of AMD, wet and dry.

Wet is the most severe form of AMD, with about 200,000 people being diagnosed each year. It is the most visually devastating. In most cases of wet AMD, the patient loses all of their central vision, leaving them with only peripheral. Both wet and dry AMD are treated with either Lucentis or Avastin. Both are eye injections. Lucentis is $200 per injection, and Avastin is only $50 per injection. Both drugs have shown to be effective in decreasing vision loss, but it was unsure as to which drug was more effective. It would make sense that Lucentis is more effective because of how much more expensive it is.

In this study, patients were enrolled by a 2:1 ratio to receive either the Avastin or Lucentis. Patients were given eye injections of Avastin or Lucentis every month for the first three months, followed by monthly examination and testing. They received further injections on an as needed basis for one year.

Fifteen patients received Avastin and seven patients received Lucentis. There was no significant difference in visual acuity and anatomic outcomes between the two groups. Both groups had an average improvement in vision of 1.5 lines on the vision testing chart, and only one patient (who was in the Lucentis group) lost a significant amount of vision (three lines or more). In addition, patients in the Avastin group underwent an average of eight injections over one year, while patients in the Lucentis group underwent an average of four injections.

"With the exception that total injections given to subjects over one year were significantly different between the two treatment arms, visual and anatomic outcomes at one year failed to show a significant difference between both groups," lead author and Principal Investigator, Manju Subramanian, MD, an assistant professor in Ophthalmology at BUSM was quoted as saying. According to the authors, further studies with larger sample sizes are warranted.

Considering that the study showed no differences in outcomes it would be more economical to use Avastin.

SOURCE: Eye, published online October 2010