Cochrane collaboration says side effects of expensive Lucentis and off-label Avastin are similar

Independent researchers at the Cochrane Collaboration have added weight to the argument that health services should use the cancer drug Avastin (bevacizumab) to treat age-related wet macular degeneration (AMD), instead of the more expensive Lucentis (ranibizumab), despite Avastin not being approved for treating the eye disease.

The two drugs are both derivatives of the same antibody, which inhibits blood vessel growth. Both were developed by Genentech, the biological drugs subsidiary of Roche, but Lucentis is marketed by Novartis outside the US. Because Avastin is so much cheaper than Lucentis, health services could make significant savings by using it for AMD. However, the companies are disinclined to pursue regulatory approval for Avastin in AMD, which has led to claims of anticompetitive behaviour.

Cochrane’s systematic review of the available comparative study data suggests that the side effect profiles of the two drugs are not significantly different, and doesn’t support favouring Lucentis over Avastin. However, the researchers admit that the statistical power of their analysis is low, and are preparing a larger review, taking in other sources of evidence.

Responding to the review, Novartis maintains that Avastin is not appropriately formulated for injection into the eye – doctors need to split the large doses supplied for cancer treatment into much smaller doses for AMD. A company statement also points to the mandatory continuous safety monitoring system that ensures reporting of side effects for approved treatments, but which it asserts is not in place for off-label use.