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Surgeons question Avastin safety
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RIO GRANDE, Puerto Rico — An informal poll of retina’s leading thinkers showed about 85% believe intravitreal bevacizumab is safe enough to use on their parents, and more than 90% believe in the drug’s ocular safety. Paul E. Tornambe, MD, recapped highlights of this year’s Masters of the American Society of Retina Specialists meeting, with an estimated attendance of about 50. This year, the main focus was on Genentech’s Avastin (bevacizumab) and Lucentis (ranibizumab), both for the treatment of age-related macular degeneration.
“The gold standard of treatment for AMD will probably be Lucentis,” he said. Avastin most likely will continue to be used intravitreally after Lucentis receives U.S. approval “for non-AMD treatments.”
The retinal community is still debating the dosage levels appropriate for Avastin, Dr. Tornambe said. “We have no science behind what we’re using. Can we go even lower than what we’ve been using?” he asked.
Another issue facing retinal specialists about Avastin is its duration of action. None of the attendees would re-inject a patient at 4 weeks, but the overwhelming majority would re-inject at 6 weeks, with about 20% holding off until week 8 for the second injection. Most surgeons said they would inject three times and “see what happens.”
When combination therapy is being discussed, about half the physicians would use photodynamic therapy and Avastin as a primary treatment for AMD, while the remaining 50% would use intravitreal triamcinolone and Avastin.
“It seems most of us will use Macugen (pegaptanib, Pfizer/Eyetech) if the patient responds,” he said. Macugen may be beneficial beyond salvage therapy, he said.
While Dr. Tornambe advocated a comparison study between Lucentis and Avastin, Stephen Sinclair, MD, voiced concern that with all the attention being paid to the two medical therapies, insurance companies will be hesitant to reimburse for other drug therapies.
“We need to make insurance companies recognize there are multiple drugs available, and they should pay for whatever the physician believes will help the patient,” he said.