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Age-related macular degeneration: do not take risks in order to cut costs

In the best interests of patients suffering from age-related macular degeneration (AMD), it is better to prescribe ranibizumab, despite its inflated price, which must be challenged and reduced, as opposed to bevacizumab.

Age-related macular degeneration (AMD) affects the area of the retina called the macula and leads to the gradual reduction of vision and colour perception. “Wet” AMD causes a gradual, sometime rapid decline in visual acuity, and even a loss of central vision.

Ranibizumab (Lucentis°) administered through intravitreal injection is the reference or
second-line treatment depending on the type of AMD. Because of its lower cost, bevacizumab (Avastin°), which is similar to ranibizumab, is sometimes used off-label, even though its presentation is not appropriate for intravitreal injection.

According to independent clinical trials, the efficacy of bevacizumab after one or two years' treatment is similar to that of ranibizumab in slowing the loss of visual acuity. There are no available data for the longer term. No fewer injections are required with bevacizumab compared with ranibizumab.

The adverse effects of bevacizumab are similar to those of ranibizumab, both ocular and extra-ocular, including cardiovascular disorders. However, bevacizumab appears to expose patients to slightly more severe  adverse gastrointestinal effects. It also exposes them to a sometimes severe risk of infections due to the manipulations necessary for its preparation (since it is not sold in a form that is injectable in the eye), whereas ranibizumab has the advantage of being in the form of a pre-filled syringe designed for injecting into the eye.

The question  of ranibizumab's excessive price needs to be resolved  by the public authorities.

©Prescrire 1 September 2015

"Bevacizumab (Avastin°) and age-related macular degeneration" Prescrire Int 2015; 24 (163): 201-205. (Pdf, subscribers only).
Download the full review.
Pdf, subscribers only

See also:

In the September issue
of Prescrire International:
Aflibercept (Eylea°) and
diabetic macular oedema
(September 2015)
Free

Ranibizumab.
Macular degeneration:
second-line use due to risks
Prescrire Int 2008;
17 (93): 3-6.
Pdf, subscribers only

Bevacizumab : very
similar to ranibizumab
Prescrire Int 2008;
17 (93): 4.
Pdf, subscribers only

Macular degeneration:
photodynamic therapy, even
ranibizumab for some patients
(June 2007)
Free