CATT trial comparison Avastin and Lucentis for wet AMD

At two years, Avastin (bevacizumab) from Genentech/Roche and Lucentis (ranibizumab injection) developed by Roche and marketed by Novartis outside the USA are two widely used drugs to treat Age-related Macular Degeneration (AMD), improve vision when administered monthly or on an "as-needed" basis, although greater improvements in vision were seen with monthly administration for this common, debilitating eye disease, according to researchers supported by the National Institutes of Health. Lucentis is approved for the indication and Avastin is not approved but is commonly used on a "as-needed" basis. Prior to the Comparison of AMD Treatments Trials (CATT), a two-year clinical trial, the two drugs had never been compared head-to-head. Second year results were published in the journal Ophthalmology. CATT was designed to compare Avastin and Lucentis with monthly and "as-needed" treatment schedules. At enrollment, patients were assigned to four treatment groups defined by drug (Avastin or Lucentis) and dosing regimen (monthly or as-needed). After year one, patients initially assigned to monthly treatment were randomly reassigned to monthly or "as-needed" treatment without changing their drug assignment. At two years, visual acuity with monthly treatment was slightly better than with "as-needed" dosing, regardless of the drug. As measured on an eye chart, monthly treatment resulted in a mean improvement of about half a line better than "as-needed" dosing. Switching to "as-needed" treatment after one year of monthly treatment yielded outcomes nearly equal to those obtained with "as-needed" treatment for the full two years. Changes in retinal anatomy differed by drug and frequency of treatment, but did not have an impact on vision through two years. Both drugs were highly effective regardless of the approach to dosing. There was slightly less vision gain with "as-needed" treatment."Since "as-needed" dosing required 10 fewer eye injections over the course of two years and yielded similar visual results, many patients may choose this option.� said Daniel F. Martin, M.D., study chair for CATT and chairman of the Cole Eye Institute at the Cleveland Clinic. Avastin costs about $50 a dose whereas Lucentis costs $2000. Roche, which has never put forward Avatin for approval in wet AMD, said it believes Lucentis is the most appropriate treatment for the condition. It argues that the drugs were designed for different purposes and may have different safety profiles when used in the eye. The CATT trial revealed that serious adverse events occurred at a 40% rate for patients receiving Avastin and 32% for Lucentis.