Marilyn Chase had an good piece in the WSJ about how doctors and consumers have driven the debate over whether to use Avastin off label to treat macular degeneration for about $40 a dose or the drug Genentech developed for the disease and for which it received FDA approval. Lucentis is administered in the form of smaller molecules, which is thought to give Lucentis an advantage over Avastin in its ability to penetrate the eye's retina and halt abnormal blood vessel growth contributing to advanced macular degeneration and scarring that causes blindness. But opthamologists think otherwise. They began using Avastin as a placeholder while Lucentis was being developed and have stuck with it because it is cheaper and see no reason to change. Now the NIH is seeking to conduct a head to head trial which, if it goes the way of all large scale trials,will show no difference except in terms of side effects which is a huge exception since it relates directly to individual response to doses. And that is something that Judah Folkman observed in the Phase I trials of Avastin way back when but back then the FDA insisted everyone had to get the same dose.
So the head to head trial is really a product of one size fits all science, not Genentech's evil effort to milk profit out of Avastin, For perspective, note that in it's recent study to determine the effectiveness of Avastin in lung cancer, Genentech found that a smaller dose was as effective as a higher dose. It would behoove Genenetch and those who are setting up the Lucentis trial as a sentinel event for government run comparative effectiveness research to look at which patients do best at which dose and molecule size. That's where medicine is heading. And if we want to avoid across the board reimbursement decisions that drive one size fits all medicine, Genentech and other companies are going to have to get ahead of the curve as it did with Avastin in lung cancer. It must change the conversation with consumers and doctors by giving them different and better information.
As it can see (no pun intended), the media will not do it for them....Genentech's Big Drug For Eyes Faces a Rival