Cheaper anti-blindness drug could save NHS £85 million annually

By Dr. Ananya Mandal, MDMay 8 2012

The NHS could be saving £85 million each year by using a cheaper drug to treat a common form of blindness in the elderly, researchers claim.

Avastin (bevacizumab), which is used to treat wet age-related macular degeneration – the most common cause of blindness among the elderly costs only £60 per injection. But despite trials showing it is no less effective, another drug, Lucentis, is the current official choice, even though it costs £700 per shot. Avastin is intended to treat bowel cancer, but research by the National Institute for Health Research has shown that it also works just as effectively and safely as Lucentis in treating Wet AMD.

Around 23,000 patients a year develop the more serious ‘wet’ form of AMD, and nearly three quarters go on to suffer severe sight problems. AMD is caused by the deterioration and death of the cells in the macula, the part of the retina used to see straight ahead, and so robs sufferers of their central vision. The more common ‘dry’ form affects the eyes gradually. But one in seven of these will develop the more serious ‘wet’ form and lose their central vision almost immediately.

As a result a team of researchers from universities including Oxford, Belfast, Southampton and Bristol carried out a trial on 610 patients to investigate whether it really was as effective. The study’s initial results showed that both drugs produced almost equal benefit. But the researchers calculated that switching patients to the cheaper Avastin could save the NHS £84.5million a year, based on 17,295 eyes being treated. The study, presented at a conference by the Association for Research and Ophthalmology, looks set to further enflame a dispute between the NHS and the maker of Lucentis, Novartis.

Some doctors have been prescribing Avastin, made by Roche, for the condition to save money, even though it has not licensed for this use. Last month it emerged that Novartis, the drugs giant behind Lucentis, was taking these four trusts to court, claiming they were putting patients at risk. Experts accused the firm of trying to maximise its profits by blocking the cheaper drug.

Professor Usha Chakravarthy of Queen’s University Belfast, who led the latest research titled Ivan, said, “The results at the end of the first year show that Lucentis and Avastin have similar effectiveness.” She said both groups of patients were able to read one or more lines of letters lower down – which are smaller and harder to see – on a standard sight test. The trial was funded by NHS.

Novartis argues that Avastin is not as safe as Lucentis and claims that patients are at higher risk of stomach and gut disorders. But overall, researchers say both drugs are extremely safe.

The study noted, however, that patients on Lucentis were at a slightly higher risk of heart attack and stroke, while those on Avastin were marginally more likely  to need hospital treatment for  other problems.

“If anything, we found a higher number of [events such as] stroke and heart failure in the Lucentis arm and we found a slight excess of other adverse events in the Avastin arm, which did not reach statistical significance in our study,” said Chakravarthy. When the results from Ivan were combined with those from Catt, the extra Lucentis adverse events disappeared. “The only place where there remains cause for concern is in hospitalisations for other events,” she said. These included a range of issues, including kidney and stomach problems but, she said, they would not necessarily be a reason not to use Avastin.

A spokesman for the Macular Disease Society said, “The trials cannot provide definitive safety information and the overall question of the safety of Avastin is, unfortunately, not answered to everyone’s satisfaction by these trials. The use of Avastin will remain a matter of judgment for clinicians, with some satisfied with the evidence and others not.”

The trial is highly unusual because it is rare for the NHS to pay for straight comparisons of drugs. The vast majority of drug trials are funded by the pharmaceutical company which hopes to sell it and usually has no interest in finding out how well it works compared with a rival medicine.