New Hope for People With Macular Degeneration
A new treatment for the wet form of age-related macular degeneration--a leading cause of vision loss in people over 50--appears to be a big improvement over the current therapy. The condition occurs when blood vessels in the eye grow abnormally and leak fluid into the central retina (macula). Two studies in this week's New England Journal of Medicine found that patients given monthly injections of ranibizumab (Lucentis) in the eye to inhibit vessel growth experienced much less vision loss or more improvement than those given the usual therapy, which uses a laser to close off leaking vessels.
About 95 percent of the Lucentis group retained their vision, compared with about 60 percent of those receiving the standard treatment. And about one third of the Lucentis group actually experienced improvement; only 5 percent of the other group did. "It's amazing to have something that helps this much," says study leader David Brown, a retinal specialist at the Methodist Hospital in Houston. "One patient who was legally blind went back to 20/20 vision and was able to drive again."
The research, funded by Lucentis maker Genentech, spurred the Food and Drug Administration to approve the drug in June. The price tag is hefty: Each monthly injection costs more than $2,000. Although private insurance and Medicare will pick up most of this cost, some patients may still find themselves out of pocket $5,000 a year.
An alternative medication that works in a similar fashion may offer the same benefits for a much lower price. Genentech's Avastin, approved for colon cancer, was widely used off label to treat wet macular degeneration before Lucentis came on the market. Avastin costs about $17 to $50 per injection, but it hasn't been approved by the FDA for this use. Yesterday, the National Institutes of Health announced that it will fund a large multicenter trial to find out if the two drugs are equally effective for treating macular degeneration.
At this point, those without adequate insurance coverage might want to ask their doctors about the cheaper drug. For patients without health coverage, "we are almost always starting with Avastin," says Philip Rosenfeld, a professor of ophthalmology at the University of Miami Miller School of Medicine who has studied it in patients with macular degeneration. If it helps, he said in an E-mail from Japan, there's no need to switch over to Lucentis.
Dawn Kalmar, a spokeswoman for Genentech, says the market price of Lucentis is based on the cost of bringing the drug to market. Though not molecularly equivalent, both drugs are in a category known as monoclonal antibodies, which targets the growth factor involved in macular degeneration. Avastin is packaged in a 100-milligram dose for colon cancer patients instead of the 0.5-milligram dose used for macular degeneration. "There's always a concern when a product is used off label, particularly since we can't guarantee the purity of the product after a package is opened and divided into smaller doses," says Kalmar.