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More on Genentech and Lucentis vs. Avastin

2014-12-10

Avastin is a full-length monoclonal antibody, that is, it has both antigen binding sites the same as an antibody produced within the body.  Lucentis turns out to be a half-length monoclonal antibody, that is, it is half as big and only has one antigen binding site.  Both compounds are produced by Genentech.

Avastin has been used experimentally since 2005 for treating wet macular degeneration, and it really does work.  It does not work for its approved indication, which is adjunctive therapy in advanced metastatic cancers.  It is supplied in 100 and 400 mg vials.  To prepare an intraocular dose, one must withdraw 1.25 or 2.5 from this vial into a sterile syringe.  The contents are then injected into the vitreal humor of the eye.

Lucentis is approved for wet macular degeneration, and is distributed by the company in single-dose vials.

The major difference between these two drugs is that a vial of Avastin can be broken up into over fifty individual doses, which cuts the price down to $50 a shot.  Lucentis, on the other hand, is vastly more expensive.

The worst part about this situation is that Avastin is approved for an indication where it does no good because the patient is usually too far gone, and costs big money for those full vials that are injected intravenously.  The situation where it actually works requires the physician or a compounding pharmacy to withdraw the required amount into a syringe, making many doses from one vial and cutting the cost exponentially.

At the same time, the company produces and has had approved by the FDA a drug which is virtually identical, and testing has shown to be in reality identical in efficacy, which is conveniently supplied in individual doses for a cost even greater than that of a full vial of the Avastin it mirrors.

Thus, we have full clarity of purpose: to charge a really huge amount for a drug that works and is FDA approved, and hope to get it paid for by the patient or insurance company.  Eventually some one pays the demanded price because it really works and the alternative is eventual blindness.  The purpose is to make the largest amount of money possible.

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