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One-year results from a clinical trial show that Lucentis® and Avastin® were equally effective in preserving vision in people with wet age-related macular degeneration (AMD). Known as the Comparison of Age-Related Macular Degeneration Treatment Trials (CATT), the 1,200-participant multicenter study is the largest comparison to-date of the two popular AMD treatments. The highly-anticipated results were published online Thursday, April 28, in the New England Journal of Medicine. The study also revealed that safety of the two treatments was similar, and that effective treatment with either drug can likely be accomplished on an as-needed basis rather than through a monthly regimen. Both Lucentis and Avastin are administered through an injection in the eye, so achieving positive results through less-frequent injections is an encouraging outcome.
The National Eye Institute launched the study because Avastin is prescribed by many doctors as a low-cost alternative to Lucentis. Lucentis was approved by the FDA for treatment of wet AMD in 2006. Avastin is not approved by the FDA for the treatment of wet AMD, and is prescribed off-label for the condition. A Lucentis treatment costs approximately $2,000 per dose while an Avastin treatment for wet AMD costs approximately $50-$100. Both Lucentis and Avastin work by reversing and preventing further the growth of unhealthy blood vessels underneath the retina that are characteristic of wet AMD. “The CATT study is important because Lucentis and Avastin are both widely used as wet AMD treatments. Results from the study are helping patients and their doctors make informed decisions. It is important that patients ask their doctor which treatment is best for them,” says Stephen Rose, Ph.D., chief research officer, Foundation Fighting Blindness. “We need to keep in mind that these are interim one-year results from a two-year study. We may learn more in the study’s second year.” Participants were assigned randomly to one of four treatment groups. Two groups received monthly injections of Lucentis or Avastin, and two groups received injections of either Lucentis or Avastin on an as-needed basis. Participants who received monthly injections of Lucentis or Avastin experienced virtually the same improvement in their vision. Visual acuity improvement for patients in the as-needed group, whether receiving Lucentis or Avastin, was also nearly the same. In regard to safety, the investigators reported there was no difference between the two treatments in the rate of death, heart attack, or stroke. The rate of other serious adverse events was 24.1 percent for Avastin patients vs. 19.0 percent for those receiving Lucentis. Investigators say that a study with more patients is needed to better understand the significance, if any, of these differences in safety. Avastin was originally developed by Genentech as a treatment for certain cancers. The treatment blocks the proliferation of blood vessels that allow tumors to grow larger. Genentech later developed Lucentis, which was derived from the same monoclonal antibody as Avastin, as an approach to blocking the growth of vision-robbing, leaky blood vessels under the retina that are the hallmark of wet AMD. While Lucentis was being evaluated in clinical trials, doctors not in the clinical trials began treating their wet AMD patients with Avastin, because there were virtually no other effective therapy options available, and they knew the drugs were similar in their effect. Lucentis was approved by the FDA in 2006, though physicians continue to prescribe Avastin for wet AMD because of its low cost and effectiveness. AMD is the leading cause of blindness for people in developing countries who are 50 years of age or older. Approximately 1.5 million people in the U.S. currently have wet AMD. More than eight million individuals 50 and older in the U.S. are at risk of developing wet AMD.
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