Avastin or Lucentis in Pregnancy

We received another question late last week:

Hi. I have a retinal lesion in each eye. The right one is fine, has been stable since July 2004, when both lesions were found. The right lesion was stopped by laser. My left eye, the lesion spread into my macula...laser treatments did not work. Macugen then came out and I had over a year of treatment with Macugen in my left eye. I haven't had a shot since August 2006, my left retina lesion has remained under control since then. However, I now have some leaking and I need a shot in left eye. I am pregnant, and I am asking as to whether you have heard of any other woman being pregnant getting a shot of Lucentis? My Retinal specialist has not, nor my OB-GYN....Thanks for your time.

I have heard of one pregnant woman who had an injection of Avastin for a choroidal neovascular membrane. I believe she was in her second trimester at the time. Her eye did fine and she had a completely normal baby. Keep in mind this is anecdotal evidence and not a controlled clinical study. I don’t think anyone knows the answer as to whether either of these drugs is safe in pregnancy. Genentech [http://www.fda.gov/cder/foi/label/2006/125156lbl.pdf] states that Lucentis should be given in pregnancy only if clearly needed. Pharmaceutical companies are very leery of litigation, so I think they would not have stated this if they thought there was more than a miniscule chance that the injection would hurt the mother or child.

I would like to know how good your vision was in the left eye before this flare-up. If you had poor vision anyway, you could consider waiting. If you’ve noticed worsening vision, then I think you should be treated and that you and your baby will do fine. I would recommend Lucentis rather than Avastin because of its shorter systemic half-life.