MyVisionTest News Archive
Feb 24, 2010
Avastin and Lucentis produce same vision outcomes for AMD
There is no difference in the visual acuity (VA) outcomes after Avastin (bevacizumab) or Lucentis (ranibizumab) treatment for AMD, according to a new study.
In 2006, the United States Food and Drug Administration approved the use of Lucentis (ranibizumab) for the treatment of exudative AMD. Before its approval, many ophthalmologists already were using Avastin (bevacizumab), a drug very similar to Lucentis. Avastin is approved for the systemic treatment of certain cancers, but is not approved for injection into the eye. This "off-label" use of the drug has been reported to be effective at treating exudative AMD. Although the safety and efficacy of Lucentis is well established, the cost per injection is high. However, bevacizumab is inexpensive, but it has not been well studied.
Methods and Results
This comparative, retrospective case series followed 452 patients in a retrospective study of exudative AMD treated with anti-vascular endothelial growth factor drugs; 324 patients were treated with Avastin and 128 patients with Lucentis.
All treatment-naïve patients who received either Avastin or Lucentis were followed for 1 year. Baseline characteristics and VA were recorded using standard descriptive statistics.
At 12 months, the distribution of VA improved in both groups with 22.9% of Avastin and 25.0% of Lucentis attaining ≥20/40 (FIGURE). Improvement in vision was observed in 27.3% of the Avastin group and 20.2% of the Lucentis group. The mean number of injections at 12 months was 4.4 for Avastin and 6.2 for Lucentis. There were 8 (2%) deaths in the bevacizumab group and 4 (3%) in the Lucentis group. Two patients developed endophthalmitis in the Avastin group and the Lucentis group. The Avastin group had slightly worse acuity at baseline, but both groups showed improvement and stability of vision over time.
Discussion and Conclusions
Comparing the mean VA, changes in VA, and VA loss and gain, there did not seem to be any great differences between the Avastin and Lucentis. Some investigators have suggested that Lucentis might act faster, but this study did not find any difference.
The current study did not specify a specific treatment protocol. There was no financial incentive or disincentive for use of either agent. Choice of the drug was dependent only on physician and patient choice. The results of the study represent real-world experience of the 2 drugs.
The sample size of the current study does not have sufficient power to determine whether there are any differences in safety. In this study, the frequency of endophthalmitis was 0.2% (2/905 injections) in the Avastin group and 0.3% (2/648 injections) in the Lucentis group.
At 1 year, the number of injections varied between the 2 groups (4.4 vs 6.2 for Avastin vs Lucentis). This difference may be due in part to the belief that Avastin is a larger molecule and has a longer intraocular half-life. Interestingly, the number of injections is also greater during the first 6 months compared with the last 6 months. From baseline to 6 months, Avastin patients on average received 3.3 injections, and 1.1 injections during months 6 to 12. This may represent both physician's and patient's desires to stop treatment. This reduction of injections also seems to have reduced the VA.
In summary, the VA outcomes of Avastin and Lucentis treatments for exudative AMD are reported in a case series from a multicenter group practice. Both treatments seem to be effective in stabilizing VA loss. Although there were a large number of patients enrolled, the study was a nonrandomized comparison, therefore selection bias could mask a true treatment difference. Results from the Comparison of the Age-related Macular Degeneration Treatment Trials will provide more definitive information about the comparative effectiveness of these drugs.
WHAT IT MEANS TO YOU: This is yet another in a series of recent papers reporting on Avastin vs Lucentis comparisons. To date, no study has found any significant difference in clinical efficacy. However, like the current study, no study has been large enough, nor sufficiently long in duration to find small but potentially important differences in safety. While these smaller studies are helpful in reinforcing our clinical impression of equivalence of the two drugs, we will have to await CATT results to know if any important differences exist.
Read more...
Ophthalmology. 2010 Feb;117(2):298-302
Tags: wet AMD, Avastin, Lucentis, CATT
There is no difference in the visual acuity (VA) outcomes after Avastin (bevacizumab) or Lucentis (ranibizumab) treatment for AMD, according to a new study.In 2006, the United States Food and Drug Administration approved the use of Lucentis (ranibizumab) for the treatment of exudative AMD. Before its approval, many ophthalmologists already were using Avastin (bevacizumab), a drug very similar to Lucentis. Avastin is approved for the systemic treatment of certain cancers, but is not approved for injection into the eye. This "off-label" use of the drug has been reported to be effective at treating exudative AMD. Although the safety and efficacy of Lucentis is well established, the cost per injection is high. However, bevacizumab is inexpensive, but it has not been well studied.
This comparative, retrospective case series followed 452 patients in a retrospective study of exudative AMD treated with anti-vascular endothelial growth factor drugs; 324 patients were treated with Avastin and 128 patients with Lucentis.
All treatment-naïve patients who received either Avastin or Lucentis were followed for 1 year. Baseline characteristics and VA were recorded using standard descriptive statistics.
At 12 months, the distribution of VA improved in both groups with 22.9% of Avastin and 25.0% of Lucentis attaining ≥20/40 (FIGURE). Improvement in vision was observed in 27.3% of the Avastin group and 20.2% of the Lucentis group. The mean number of injections at 12 months was 4.4 for Avastin and 6.2 for Lucentis. There were 8 (2%) deaths in the bevacizumab group and 4 (3%) in the Lucentis group. Two patients developed endophthalmitis in the Avastin group and the Lucentis group. The Avastin group had slightly worse acuity at baseline, but both groups showed improvement and stability of vision over time.
Discussion and Conclusions
Comparing the mean VA, changes in VA, and VA loss and gain, there did not seem to be any great differences between the Avastin and Lucentis. Some investigators have suggested that Lucentis might act faster, but this study did not find any difference.
The current study did not specify a specific treatment protocol. There was no financial incentive or disincentive for use of either agent. Choice of the drug was dependent only on physician and patient choice. The results of the study represent real-world experience of the 2 drugs.The sample size of the current study does not have sufficient power to determine whether there are any differences in safety. In this study, the frequency of endophthalmitis was 0.2% (2/905 injections) in the Avastin group and 0.3% (2/648 injections) in the Lucentis group.
At 1 year, the number of injections varied between the 2 groups (4.4 vs 6.2 for Avastin vs Lucentis). This difference may be due in part to the belief that Avastin is a larger molecule and has a longer intraocular half-life. Interestingly, the number of injections is also greater during the first 6 months compared with the last 6 months. From baseline to 6 months, Avastin patients on average received 3.3 injections, and 1.1 injections during months 6 to 12. This may represent both physician's and patient's desires to stop treatment. This reduction of injections also seems to have reduced the VA.
In summary, the VA outcomes of Avastin and Lucentis treatments for exudative AMD are reported in a case series from a multicenter group practice. Both treatments seem to be effective in stabilizing VA loss. Although there were a large number of patients enrolled, the study was a nonrandomized comparison, therefore selection bias could mask a true treatment difference. Results from the Comparison of the Age-related Macular Degeneration Treatment Trials will provide more definitive information about the comparative effectiveness of these drugs.
WHAT IT MEANS TO YOU: This is yet another in a series of recent papers reporting on Avastin vs Lucentis comparisons. To date, no study has found any significant difference in clinical efficacy. However, like the current study, no study has been large enough, nor sufficiently long in duration to find small but potentially important differences in safety. While these smaller studies are helpful in reinforcing our clinical impression of equivalence of the two drugs, we will have to await CATT results to know if any important differences exist.
Read more...
Ophthalmology. 2010 Feb;117(2):298-302
