Position Paper: The Need for Head-to-Head Studies Comparing Avastin versus Lucentis

Abstract

The ophthalmological world is on edge as the title holder for the treatment of exudative age-related macular degeneration (AMD) is under threat from an apparent amateur. These two challengers have yet to compete head-to-head under the same (study) conditions. Both competitors, ranibizumab (trade name Lucentis) and bevacizumab (trade name Avastin) are vascular endothelial growth factors (VEGF) inhibitors and both are derived from the same monoclonal antibody. However, ranibizumab, which is an antibody fragment from the bevacizumab molecule with an increased binding affinity for all forms of VEGF, has been approved for the treatment of all angiographic subtypes of subfoveal neovascular AMD by the U.S. Food and Drug Administration and by the European Medicines Agency since 2006 and 2007, respectively. The approval was based on two randomized controlled trials which showed that approximately 95% of the patients treated with monthly ranibizumab injections lost fewer than 15 letters in 12 months, compared to 64% of patients receiving photodynamic therapy (PDT) and 62% receiving sham treatment. In addition, approximately every third patient showed improvements in visual acuity. Serious ocular adverse effects under monthly ranibizumab injections were in the order of 1--2% over a 2-year treatment period. In sharp contrast to ranibizumab, bevacizumab was not developed for the treatment of AMD and