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Preserving Avastin for AMD saves sight and money

A combination of medication and technology has improved the lives of millions around the world

Howard Larkin

Posted: Thursday, November 1, 2018

Philip J Rosenfeld MD, PhD, who presented the Jackson Memorial Lecture at the AAO 2018 Annual Meeting in Chicago

In 2003, the convergence of two “heavenly” technologies, optical coherence tomography (OCT) and vascular endothelial growth factor inhibitors (anti-VEGF), led to a revolution in treatment of neovascular age-related macular degeneration (AMD). For the first time the disease could be halted and vision not just stabilised but improved in many cases, and progress could be monitored to guide additional treatment, said Philip J Rosenfeld MD, PhD, in the Jackson Memorial Lecture at the AAO 2018 Annual Meeting in Chicago.

Since then many studies, including early phase trials of ranibizumab (Lucentis) conducted by Dr Rosenfeld, of Bascom Palmer Eye Institute, University of Miami, US, have demonstrated the efficacy of OCT-guided therapy for treating wet AMD. OCT guidance reduces the need for frequent injections without reducing efficacy, which have helped make it the most frequently used dosing strategy throughout the world. However, before ranibizumab could be approved by the FDA, Dr Rosenfeld and others in 2004 showed that bevacizumab (Avastin), a compound developed for treating cancer of which ranibizumab is a fragment, also was effective – at about 1/40th the price.

Over the next few years Dr Rosenfeld and others overcame resistance from the FDA and the manufacturer of both drugs to establish bevacizumab as effective for many neovascular eye conditions, and keep it available for off-label use. These efforts included a study sponsored by the US National Eye Institute that found the two drugs equally effective.

Several studies suggest that availability of bevacizumab and the reduced dosing enabled by OCT have saved the US Medicare program alone more than $40 billion, Dr Rosenfeld said. That does not include savings from other indications, such as diabetic retinopathy and retinal vein occlusion. More important, they have allowed many more people around the world to benefit from the sight-saving effects of anti-VEGF treatment.