Doctors warn against using Avastin for macular degeneration
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c2483 (Published 07 May 2010) Cite this as: BMJ 2010;340:c2483
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Sir, In BMJ 2010;340:c2483 the NHS is urged to not consider using
avastin for the treatment of age related macular degeneration (AMD) prior
to the publication of randomised clinical trials assessing avastin's
efficacy cf. lucentis. We agree that this is the gold standard of evidence
which is required. However in Southampton we have a unique situation which
may be of interest to this debate. We treat patients referred to us by the
Gurensey Board of Health (who are not bound by NICE guidance) with avastin
and our NHS patients with lucentis.
We recently audited one hundred patients who had received intra-
vitreal avastin or lucentis for AMD between 2006-2009. 50 patients
received Avastin and 50 patients received Lucentis. Follow-up was
restricted to 12 months for analysis purposes.
Our results showed that 12 months from baseline the Avastin Group
improved by 0.3 ETDRS letters and the Lucentis group improved by 0.9
letters. This was a not significnat difference in visual acuity (P =
0.9890).
Therefore our unique experience suggests that avastin can be used
effectively in the management of AMD in a UK NHS hospital setting.
Competing interests:
AL has received educational grants and served on advisory boards for Novartis.
Competing interests: No competing interests
Position of Royal College of Ophthalmologists on the use of Avastin
Doctors warn against using Avastin for macular degeneration (15 May
2010) contained many correct facts but did not accurately reflect the
College’s position which is:
• Our paramount concern is the safety of patients.
• The College has publicly called for comparative trials of ranibizumab
and bevacizumab on several occasions. It is appropriate for the Department
of Health to examine whether there are safe, efficacious and cost-
effective alternatives to existing treatments. NICE can review an
unlicensed, or off-label drug, using the same process for reviewing the
evidence of safety and efficacy as for a licensed drug.
• It is important that the UK comparative (IVAN) trial receives support
from ophthalmologists and NICE has indicated that it would only wish to
proceed once the trial has reported. Bevacizumab is widely used in
mainland Europe and North America and there is an accumulating body of
evidence from other trials, published case studies and expert opinion
which, although not of as high quality, can and should be reviewed on its
merits. NICE may conclude that it cannot reach a firm verdict on whether
ranibizumab and bevacizumab can be regarded as equivalent in terms of
safety and efficacy, but it is still a legitimate question to ask.
We support the full disclosure of any possible conflicts of interest
and Mr Winfried Amoaku has asked me to point out that he has participated
in research sponsored by pharmaceutical companies including Allergan,
Bausch and Lomb, Novartis, and Pfizer, and has received educational travel
grants, and honoraria from Allergan, Novartis and Pfizer for serving on
various ad hoc advisory panels. Novartis manufactures ranbizumab outside
the US, whilst bevacizumab is manufactured by Roche/Genentech.
Competing interests:
None declared
Competing interests: No competing interests