BLOG: Avastin W
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Having a ninth grade son, I get to hear a lot of teen slang. For example, “no cap” means no kidding, and when he lands a trick on his skateboard, he calls it a “W” for win.
We are scoring a number of W’s in the ecosystem of drugs to treat exudative macular degeneration and diabetic retinopathy, but we have a big L on our forehead when it comes to their cost. In the past year, we’ve seen continued evolution of the anti-VEGF products, like the introduction of faricimab and high-dose aflibercept. As the cover story in this issue of Healio | OSN describes, these drugs do indeed extend the durability of these products, with typical patients requiring re-treatment after as much as 4 months. Results vary, but safety profiles seem to be acceptable, so there is little doubt that there will be market acceptance, if not enthusiasm, for these drugs.
Let’s think back to the history of eye drops like ketorolac and brimonidine, which were first FDA approved in 1992 and 1996, respectively. As each drug variation neared its loss of patent exclusivity, Allergan, the manufacturer, produced an FDA-approved refinement on the product. Each refinement involved a change in concentration or preservatives, prolonging the drug’s effectiveness or reducing the side effects it caused. Each refinement, called in the industry a “line extension,” allowed the manufacturer to continue its high-margin sales on the drug for several more years. And each refinement added a letter. Alphagan became Alphagan P. Acular became Acular LS. Of course, it wasn’t just Allergan that harnessed line extensions to prolong profitability. Alcon did so with Nevanac, which became Ilevro. Ista followed suit with Xibrom, which became Bromday, which later became Prolensa under Bausch + Lomb.
Making small changes to a drug and repackaging it as a new product is a low-risk, high-reward way of turning a profit in pharmaceuticals. For more than a decade, these manufacturers kept generic products from erasing their sales. Line extensions aren’t bad for patients either; each new drug does indeed offer a benefit, although cost-benefit ratio is up for some debate.
This is not to diminish the importance of the new retina drugs and delivery systems. Faricimab is an entirely new compound with what appears to be a dual mechanism of action. And products like Genentech’s Port Delivery System for ranibizumab can allow patients a true 6-month interval between injections. Having a close family member who receives regular injections for AMD, I can attest to the real-world benefits of extending treatment intervals.
However, all this innovation comes at a cost. Even biosimilar products, which are the closest approximation of a generic to a biologic product, are expensive. Byooviz (ranibizumab-nuna, Biogen/Samsung Bioepis), a “generic” for Lucentis (ranibizumab, Genentech), still costs $1,100 per dose compared with Lucentis at $1,800.
What we need is another low-cost but more effective version of the time-honored drug Avastin (bevacizumab, Genentech). To be fair, this is a tall order. The manufacturing of these biologic products is complex, as is the need for refrigeration in shipping. But if compounding pharmacies can provide these products for under $100 per dose, there must be a way to improve them while preserving their affordability. If we could do that, I’d name it Avastin W.
Follow @DrHovanesian on X (Twitter).
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