Observations Medicine and the Media

Off-label prescribing in macular degeneration

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d6778 (Published 19 October 2011) Cite this as: BMJ 2011;343:d6778
  1. Margaret McCartney, general practitioner, Glasgow
  1. margaret{at}margaretmccartney.com

Are doctors being pushed into prescribing an off-label drug? The newspapers wrongly claim that giving bevacizumab rather than ranibizumab sacrifices safety for financial reasons. Margaret McCartney investigates

The drug company Novartis stands to lose a hefty slice of income if most patients with macular degeneration in the United Kingdom are treated with the cheap cancer drug bevacizumab (Avastin) instead of the more expensive eye drug ranibizumab (Lucentis), which, unlike bevacizumab, is licensed specifically for that condition (www.inpharm.com/news/168782/novartis-lucentis-price-cut-switzerland). Both drugs are made by Roche, and the more expensive one is marketed in the UK by Novartis.

Novartis has produced research showing that patients do not like the idea of being given an unlicensed drug for their condition. And now some newspapers are claiming that doctors are being pushed into prescribing the cheaper drug. But are they really being pressurised to do so, and would it matter if they were? The background is this: bevacizumab costs about £85 (€98, $134) an injection, compared with £740 for ranibizumab (http://blogs.bmj.com/bmj/2011/06/28/james-raftery-avastin-lucentis-and-nice). Ranibizumab is licensed to treat macular degeneration; bevacizumab is not, but it has been proved to be just as effective in doing so.

Evidence that some places are seeking savings by turning to bevacizumab comes from the SHIP (Southampton, Hampshire, Isle of Wight, and Portsmouth) cluster of primary care trusts, which recently calculated that …

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