Vision-Loss Drug Hailed As Cheaper One is Studied

By Jacob Goldstein

A NEW DRUG CAN HALT — and sometimes reverse — loss of vision caused by wet macular degeneration, a leading cause of blindness, according to a new study.

But the drug, Lucentis, costs about $2,000 per monthly dose.

"It’s a phenomenal breakthrough — at a price," said Dr. Philip Rosenfeld, the University of Miami/Bascom Palmer researcher who led the study. "Can we accomplish the same miraculous benefits using a less-expensive drug, and is the less-expensive drug safe over the long term?"

To answer those questions, scientists are looking to Avastin, a drug that costs about $50 per dose.

Before the Food and Drug Administration approved Lucentis in June, the only patients allowed to receive it were those participating in clinical trials. That limitation prompted Rosenfeld to begin using Avastin — which was approved in 2004 to treat colon cancer and is a close molecular relative of Lucentis — to treat macular degeneration. (Doctors are permitted to use drugs for purposes other than those approved by the FDA.)

Rosenfeld quickly saw good results in many patients, and last year he reported his findings in journals and at conferences. By the time Lucentis was approved, thousands of patients had been treated with Avastin for macular degeneration.

SAME COMPANY

The biotechnology giant Genentech developed both Lucentis and Avastin. The company has not expressed interest in conducting a trial that might show that Lucentis — which could generate billions of dollars in sales — works no better than Avastin.

But the National Eye Institute, part of the National Institutes of Health, will likely fund a head-to-head study of the two drugs, said Dr. Frederick Ferris, the NEI’s clinical director.

Wet macular degeneration occurs when abnormal blood vessels grow at the back of the eye. The vessels can leak, causing irritation and the formation of scar tissue, which leads to the loss of vision. (The drugs do not help patients with dry macular degeneration, a different form of the disease.)

In the study, published today in the New England Journal of Medicine, 5 percent of those who received Lucentis had a significant loss of vision, while 38 percent of those who did not receive the drug lost vision. Roughly 29 percent of those given the drug saw improvement in their vision, compared with 5 percent of those who did not receive the drug.

Both Lucentis and Avastin are based on an antibody that neutralizes the growth of new blood vessels. To create Lucentis, scientists made a shorter version of the antibody to easily penetrate the eye. But it’s unclear whether Lucentis is more effective.

Local ophtalmologists said they use both Avastin and Lucentis.

CONSISTENT SUCCESS

Dr. Pedro Lopez, who practices at the Baptist Medical Arts Building, said he has seen consistent success with Avastin — and added that even a 20 percent co-pay for Lucentis can amount to $400 a month.

Sam Grau, who is 77 and lives in Delray Beach, received his first shot of Avastin last summer from Dr. Larry Halperin, a Fort Lauderdale ophthalmologist.

Grau had already lost most of the vision in his left eye and his right eye was starting to go as well.

The Avastin stopped the deterioration.

"I watch television, I walk around, I get along very well," he said. "If my right eye was like my left eye I would be blind."