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Feature Eye Drugs

Why using Avastin for eye disease is so difficult

BMJ 2012; 344 doi: (Published 01 May 2012) Cite this as: BMJ 2012;344:e3012
  1. Ingrid Torjesen, freelance journalist
  1. 1London, UK
  1. ingrid_torjesen{at}

Use of bevacizumab rather than ranibizumab for wet age related macular degeneration has the potential to save substantial sums. But, as Ingrid Torjesen reports, the drug company is fighting to protect its profits

Ranibizumab (Lucentis) and bevacizumab (Avastin) are both commonly used to treat wet age related macular degeneration (AMD) in the United Kingdom. Many primary care trusts, which pay for treatments in England, see little difference between them, other than the price: ranibizumab costs around 12 times more than bevacizumab.1

But Novartis insists there are subtle and important differences between them in terms of effectiveness and safety, and, most importantly, ranibizumab is licensed for wet AMD and is recommended by the National Institute for Health and Clinical Excellence (NICE), whereas bevacizumab is not. Some cynics might describe it as clever marketing.

Both drugs were developed by Genentech, which is now owned by Roche. They are derived from the same antibody and work by blocking vascular endothelial growth factor (VEGF) to slow down or stop abnormal growth of blood vessels. Bevacizumab was developed as an anticancer drug and licensed in Europe in 2005. Ranibizumab was licensed for macular degeneration in 2007. Roche holds the licence for bevacizumab and in the US sells ranibizumab through Genetech, while outside the US Novartis manufactures and holds the licence for ranibizumab.

Before ranibizumab was licensed, ophthalmologists realised that bevacizumab was likely to have the same effect and some started using it off-label for wet AMD.

With primary care trusts under financial pressure, an increasing number are considering allowing ophthalmologists to use the cheaper bevacizumab for wet AMD, a move that would affect Novartis’s profits dramatically.

Novartis argues that ranibizumab is the more effective and safer product for the indication and points out that there are potential repercussions for doctors and hospitals using bevacizumab …

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