Lucentis vs Avastin: Is one drug better than the other? As the debate rages over whether Lucentis or Avastin is the drug of choice for treating wet AMD, several papers appeared in the literature this past month that adds fuel to the fire. The new research makes choosing between these two drugs more difficult than ever.

First, a retrospective chart review appearing in the British Journal of Ophthalmology compared patients receiving Lucentis or Avastin for exudative AMD. It finds that both drugs are equally effective in decreasing macular thickness and volume, but than Avastin lasts longer. Good, right? Well, not so fast.

In a paper appearing in Graefes Archive of Clinical and Experimental Ophthalmology, researchers find that Avastin, but not Lucentis, accumulates within retinal pigment epithelial (RPE) cells. The study, which examined pig eyes, concluded that there are substantial differences in the pharmacokinetics of these two drugs.

In yet another study published last month, this time in Investigative Ophthalmology and Vision Science, researchers report that higher doses of Avastin, but not Macugen, were associated with greater apoptosis (cell death) of photoreceptors. The study was conducted on rabbit eyes, but the investigators suggested that their findings "may be of some importance for patients with AMD, diabetic retinopathy, or macular edema in which anti-VEGF therapy may last many months."

So, looking at these three studies, what are we to conclude? The fact that we may need to inject less frequently with Avastin is an important advantage, but the knowledge that this could be because it is more heavily absorbed into the tissue and potentially causing greater long-term toxic effects may be an important disadvantage. So, at present, neither drug is clearly superior to the other.