macular degeneration
Wet AMD: Avastin
Avastin ® (Bevacizumab) Anti VEGF Therapy.
Avastin is the parent molecule of Lucentis. Where Lucentis is the antibody fragment, Avastin is the whole antibody. Avastin is licensed as cancer therapy in patients with advanced lower bowel cancer. The close similarity of the Avastin molecule to the Lucentis molecule prompted United States Ophthalmologists to use Avastin for Wet AMD. Their positive experiences led to a rapid acceptance by many macular degeneration specialists that Avastin has an important role to play in treating patients with wet AMD.
Numerous studies have used a tiny fraction of the normal dose used for patients with bowel cancers, given directly into the eye in the same way as Macugen and Lucentis. One recent report showed dramatic clinical improvement after just one injection in around 40% of eyes together with a very significant average vision improvement in a group of 79 patients. There are now numerous individual case studies and case series published supporting the safety and effectiveness of Avastin in Wet AMD and other conditions such as retinal vein occlusion.
When Avastin was used at the very high doses given by intravenous injection fortnightly for bowel cancer, a small (~1%) increase in the risk of developing stroke or heart attack was noted. Most ophthalmologists feel that the fractional doses of Avastin used as injection into the eye for wet AMD would very likely present a much lower risk increase of such adverse events. It is not however possible to assume that the risk is entirely abolished. Evidence supporting Avastin's safety and effectiveness in wet AMD continues to emerge on an almost monthly basis, however at present there are no large scale clinical trials for Avastin in Wet AMD. Avastin is therefore used as an "off label" therapy for Wet AMD both in the USA and across Europe. It is difficult to foresee a position in which local primary care trusts would be likely to fund the costs of Avastin treatment on the NHS without prior NIHCE approval. NIHCE are not planning to evaluate Avastin for Wet AMD in the foreseeable future.
Results
