Thursday, September 06, 2007

Avastin/Lucentis Update 15: The Brits Join in on the Fight

Apparently, British doctors are joining the fight against the high price of Lucentis and have called for a comparative study with Avastin, similar to the one about to begin in the U.S., funded by NEI/NIH. I just came across this newspaper article written a little over a month ago in The Guardian.

Please see the addendum added at the end of this article for an important update.

NHS doctors challenge high drugs prices

Sarah Boseley, health editor, The Guardian
Monday July 30, 2007

British doctors are to rebel against high prices set by pharmaceutical companies for their products by giving patients a cheap but unlicensed drug that prevents blindness, the Guardian has learned.

Unable to afford to treat all those losing their sight with a licensed and extremely expensive drug, Lucentis, some primary care trusts are giving NHS doctors the green light to use tiny shots of a similar drug, Avastin, which is marketed for bowel cancer, but costs a fraction of the price. Avastin is widely used for eye complaints in the United States.

A call from the former health secretary, Patricia Hewitt, for Avastin's manufacturer to put the drug through trials for wet age-related macular degeneration went unheeded. Now the NHS is funding a groundbreaking trial which will compare Avastin directly with Lucentis. Both drugs are manufactured by Genentech.

The moves represent the first real challenge in this country to high prices set by drug companies. There is growing unease at the cost of new drugs and high prices have led to the banning or rationing of some medicines in the NHS by the National Institute for Health and Clinical Excellence (Nice). The companies say they need billions of dollars in sales to recoup their research and development costs, but critics accuse them of profiteering.

Meanwhile, in the developing world, unaffordably high drug prices have brought the pharmaceutical industry into disrepute, forced their prices down and led to successful campaigns to allow generic copycat companies to sell cheap versions of drugs.

Around 26,000 people develop wet age-related macular degeneration (AMD) every year - a condition that can make them blind within months. Lucentis can save and even improve their vision - but Genentech, the manufacturers, and Novartis, who market it in the UK, have set the price so high - at £761.20 per injection - that Nice has said it should only be used in the 20% worst cases and then only when patients have already lost the sight of one eye.

Appalled at the implications, a number of ophthalmic surgeons in the UK are now offering treatment with Avastin, a very similar but bigger molecule also made by Genentech but licensed for bowel cancer. One bowel cancer phial can be split into many tiny doses suitable for injection into the eyes, costing as little as £10 a shot. In spite of the absence of trials or a licence, the use of Avastin has spread through the US and there is now data on more than 7,000 patients. It has also been used by some private clinics in the UK.

In the Greater Manchester area, public health directors of PCTs have taken the unprecedented decision to offer patients Avastin on the NHS. "We think as many people as possible should be treated for wet AMD. To afford it we need to use Avastin," said Peter Elton, director of public health for Bury, who is leading on the issue for the Greater Manchester area. "If you have only got one eye affected, the other eye might get something else the next year. By the time you come to treat the wet eye, it has gone too far. We think that is not ethically acceptable."

He and his colleagues are happy with the evidence amassed so far and he points out that Medicare, the state-funded healthcare service in the US, is using Avastin in 48 out of 50 states.

Moorfields eye hospital in London, the most famous in the country, is also exploring a scheme to use Avastin on the NHS. But the stakes are so high for the NHS that it is taking the unprecedented step of funding a trial which will directly compare the use of Avastin and Lucentis in wet AMD.

Further investigation has uncovered an additional information source on this story. PharmaTimes World News has published the “story behind the story”, providing further background about the reasons behind the push by British ophthalmologists to avoid the use of Lucentis and push for the approval to use Avastin in treating their AMD patients. For the complete story, follow this link.


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