Genentech in Competition With Itself on Eye Drug - New York Times

Retina specialists leading the fight for massive savings to medicare in the treatment of macular degeneration...
Genentech in Competition With Itself on Eye Drug - New York Times: "Lucentis, a drug being developed by Genentech to treat an eye disease that causes blindness in the elderly, is facing competition from a drug that some doctors say they think is as effective, but less than one-tenth the price. The rival drug's maker? Genentech."

The other Genentech drug is the blockbuster Avastin, which is approved for treatment of colorectal cancer. In the last few weeks many specialists have started using Avastin off-label as a treatment for age-related macular degeneration, the eye condition for which Lucentis is being developed....

Avastin is not an inexpensive drug, costing $4,400 a month. But doctors are now having pharmacists divide vials of Avastin into tiny portions to be injected into the eye. The amount needed for each injection costs only about $30 to $100....

That is much less than the cost of Macugen, a drug already approved for macular degeneration that is sold by Pfizer and Eyetech Pharmaceuticals, and goes for about $1,000 per injection. While Genentech has not discussed its pricing plan for Lucentis, it has been expected to cost at least as much as Macugen because it has been shown to be more effective in clinical trials. Some doctors think Avastin will require less frequent injections than Macugen or Lucentis.

Officials from the American Academy of Ophthalmology have urged Genentech to support clinical trials to study Avastin for macular degeneration. But so far Genentech has declined.

"Genentech's first priority is to their stockholders," said Dr. Rosenfeld. "Physicians have an ethical responsibility to our patients. There is an inherent conflict there."

She ( Dr. Susan Desmond-Hellmann, Genentech's president for product development) said that Genentech had spent six years proving Lucentis was safe and effective for macular degeneration. "In our view," she said, "spending the next six years to do the same thing for Avastin doesn't add a lot of value for patients."

Some physicians are holding back on use of Avastin. "I'm very hesitant to use it when I have the option of using an approved drug I know is safe," said Dr. Lawrence J. Singerman, referring to Macugen. Dr. Singerman, president of Retina Associates of Cleveland, is a consultant to Eyetech, the developer of Macugen.


Some of the off-label use of Avastin may end once Lucentis is approved. In the meantime, Genentech is beginning a clinical trial that would offer Lucentis to 5,000 patients at no cost, a move analysts say is mainly aimed at stopping doctors from using Avastin.

Dr. Rosenfeld said that even after Lucentis was approved, he suspected some doctors would continue to use Avastin, in part because of costs.

"Avastin is not going away," he said. "Hopefully, Medicare will support us as well, because potentially this could be a huge cost saving."