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Vision Health

Cheaper Drug for Macular Degeneration

Neovascular macular degeneration is a progressive and chronic disease of the eye, and a leading cause of blindness in older people. About one in 10 people with macular degeneration suffers legal blindness. Bevacizumab is a drug that has been developed to treat cancer, while ranibizumab is marketed specifically for age-related macular degeneration. The two drugs are better known by their brand names Avastin® (bevacizumab) and Lucentis® (ranibizumab). The authors of a review done at the University of Milan and published in September 2014 in Cochrane Review conclude that health policies that favor the much more costly ranibizumab instead of bevacizumab for macular degeneration, for reasons of safety, are not supported by current randomized controlled trial evidence. A larger Cochrane Review, which will assess additional sources of evidence, is now planned to help reduce the remaining uncertainties around the relative benefits and safety of these drugs.

A release from the publisher notes that bevacizumab and ranibizumab are related biological drugs that work to prevent the abnormal growth and swelling of blood vessels that are characteristic signs of macular degeneration. Although the beneficial effects of the two drugs are believed to be similar, only ranibizumab has been licensed as a treatment for macular degeneration. Bevacizumab is currently approved only as a cancer therapy. Despite this, an unlicensed preparation of bevacizumab is often used off-label as treatment for macular degeneration because it is cheaper than ranibizumab. It has been suggested that the two drugs have different safety profiles, such that bevacizumab might cause more systemic harms, and the review investigated this concern.

The release quotes Lorenzo Moja from the University of Milan as saying, “This review represents an important step forward in the knowledge about differences in systemic harms between bevacizumab and ranibizumab and mitigate past disputes around evidence. The review authors were able to collect evidence from nine trials, including three unpublished studies, while most other reviews focus primarily on published data. This result was possible through the collaborative effort of researchers across several countries (France, Germany, Italy, UK, and USA), many of who were involved in the original trials. It shows a remarkable level of commitment of trialists and healthcare systems to answer an important clinical question. I am unaware of other examples with such a large number of head-to-head non-industry sponsored RCTs”.

Dr. David Tovey, Editor-in-Chief of The Cochrane Library, added “This review addresses a question of immense importance to health systems in many countries. One of the many considerations in decision-making at policy level is not just understanding how effective treatments are, but also weighing up evidence of their safety.”

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