AMD: Avastin as effective as Lucentis according to experts

Whether or not to authorize Avastin (Roche) in the treatment of age-related macular degeneration (AMD): the debate has been raging for almost two years. This anticancer drug represents a cheaper alternative to Lucentis (Novartis), but its opponents consider it less safe. A Cochrane review resolves the question: bevacizumab (Avastin) is as safe as ranibizumab (Lucentis).

Experts reviewed 9 randomized controlled trials, which compare the effectiveness and safety of the two drugs. Their mechanism of action is the same: to prevent the abnormal growth of blood vessels, as well as their swelling, which are two characteristics of AMD. A total of 3,665 patients, treated for one or two years, were analyzed. The stakes are high: while Lucentis costs 900 € per injection, Avastin only requires 30. The results conclude that the treatments are comparable, except for gastrointestinal disorders, which are more frequent with Avastin.

Poor quality studies

However, the authors of this work take caution because they perceive differences between the two drugs, but these differences are not statistically significant. As a result, the authors of this review do not exclude the possibility that Avastin causes more side effects than Lucentis. According to studies, the death rate ranges from 27 to 53 per 1,000 people treated with the cheapest drug, and is 34 per 1,000 with the other treatment.

The same is true for the adverse effects: there are 222 per 1,000 people treated with ranibizumab, 200 to 291 per 1,000 patients under bevacizumab. But, the studies being of poor quality, the researchers advance with caution: as it is, it is impossible to say with certainty that Avastin is more dangerous or safer than Lucentis. On the other hand, its effectiveness is equivalent. To resolve the remaining uncertainties about the benefits and safety of the drugs, a second, larger Cochrane review is planned.

In France, the debate was closed last July: the National Assembly authorized Avastin within the framework of the bill for the corrective financing of social security 2012 (PLFRSS). The amendment, tabled by the PS deputy Gérard Bapt, invoked reasons of “public health. Because even before being officially authorized, bevacizumab was prescribed off-label, because of its more moderate cost.