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
Published: Thursday, November 1, 2018
[caption id="attachment_13304" align="alignleft" width="768"]
Philip J Rosenfeld MD, PhD, who presented the Jackson Memorial Lecture at the AAO 2018 Annual Meeting in Chicago[/caption]
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.
Philip J Rosenfeld MD, PhD, who presented the Jackson Memorial Lecture at the AAO 2018 Annual Meeting in Chicago[/caption]
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.
Tags: anti-VEGF, neovascular age-related macular degeneration
Latest Articles
Organising for Success
Professional and personal goals drive practice ownership and operational choices.
Update on Astigmatism Analysis
Is Frugal Innovation Possible in Ophthalmology?
Improving access through financially and environmentally sustainable innovation.
iNovation Innovators Den Boosts Eye Care Pioneers
New ideas and industry, colleague, and funding contacts among the benefits.
Making IOLs a More Personal Choice
Surgeons may prefer some IOLs for their patients, but what about for themselves?
Need to Know: Higher-Order Aberrations and Polynomials
This first instalment in a tutorial series will discuss more on the measurement and clinical implications of HOAs.
Never Go In Blind
Novel ophthalmic block simulator promises higher rates of confidence and competence in trainees.
Simulators Benefit Surgeons and Patients
Helping young surgeons build confidence and expertise.
How Many Surgeries Equal Surgical Proficiency?
Internet, labs, simulators, and assisting surgery all contribute.