The Treatment of Choice (December 2006)

The last blog showed that Avastin and Lucentis are the treatments of choice for wet AMD. Over the last few months at Iowa, we’ve used slightly more doses of Lucentis than Avastin. I’m a little surprised that the numbers of Avastin injections have remained that high. Perhaps I shouldn’t be because a survey that was presented at the Retina Subspecialty Day before the meeting of the American Academy of Ophthalmology, showed that many retinal specialists are still primarily using Avastin in lieu of Lucentis. The reasons are that Avastin is much cheaper and presumably has to be given every six weeks instead of every four weeks.

I’ve been asked, and have asked many of my colleagues, whether they think one drug is better than the other. I think that Lucentis is slightly better. It seems to cause resolution of the fluid a little more often than Avastin. I cannot say whether the visual results are better with Lucentis. I also cannot say if using Avastin first and then Lucentis only if the fluid doesn’t resolve, would be deleterious to the patient. We’re starting a study, chaired by Dr. Daniel Martin at Emory, this spring which will compare Avastin with Lucentis. This randomized study will answer the Avastin versus Lucentis question.

For now, I use Lucentis as a first line of treatment for my patients with AMD because I think it works a little better. Remember though, “impressions” can be wrong.

If you are a patient who has Medicare only, and therefore would have to pay the 20% deductible for the expensive Lucentis, I think it would be perfectly fine if your doctor started with Avastin, which works very well most of the time. There are also many fine retinal doctors who still use Avastin most of the time.