Doctors Reconsider Avastin Eye Injections amid Infection Fears

Several clusters of blinding eye infections have some doctors rethinking the common practice of using <"">Avastin off-label to treat wet, age related macular degeneration. According to a report from The New York Times, some physicians are now worried that using Avastin in this way could leave them open to medical malpractice lawsuits.

Avastin is approved to treat a number of cancers, including metastatic colon cancer, non-small cell lung cancer, kidney cancer and glioblastoma multiforme, an incurable brain cancer. However, it’s long been used off-label to treat wet, age related macular dengeration, as an alternative to the much more costly drug, Lucentis.

Both Avastin and Lucentis are made by Genentech, and work in a similar manner. But as we’ve reported previously, while Avastin only costs around $50/dose, Lucentis comes in around $2,000/dose. Avastin, however, is sold in larger doses, so in order to be used for eye injections, it must be repackaged. When the drug is divided into smaller doses, usually by a compounding pharmacy, bacterial contamination can occur.

In August, the U.S. Food & Drug Administration (FDA) issued an alert after Avastin eye injections prepared at one Hollywood, Florida, pharmacy were linked to a cluster of blinding eye infections in the Miami area. Since then, Avastin eye infection clusters have been reported at VA facilities in Tennessee and Los Angeles, California.

Now it seems, some doctors are reassessing their use of Avastin eye injections, despite the cost savings such treatments offer both patients and Medicare.

“Why would I want to risk my family to save America $1,950 a dose?” Dr. Robert Feig, a retina specialist in Brooklyn and the Bronx, told The New York Times. He cited a fear of malpractice lawsuits should Avastin injections cause eye infections in his patients as the reason for his recent decision to switch to Lucentis.

However, according to the Times, similar infections have been known to occur with Lucentis. For example, data from clinical trials involving 140,000 injections of either Avastin or Lucentis found that rate of endophthalmitis, an inflammation of the eye caused by infection, was identical for the two drugs, occurring about once every 2,000 injections.

Another study published this month in the journal Ophthalmology which followed 27,736 consecutive injections over 17 months found the rate of endophthalmitis was 1.1 of every 1,000 Avastin injections verses 0.66 of every 1,000 Lucentis injections. According to the Times, that difference was not considered statistically significant.

If all doctors switched to Lucentis, “You are going to tremendously jack up the cost to the country and achieve absolutely nothing,” Dr. Jon Adleberg, a retina specialist in Chesapeake, Va., told the Times.

Still, the recent rash of eye infections has others getting out of the business of Avastin eye injections. In Los Angeles, the pharmacy company that was supplying Avastin to Harbor-U.C.L.A. Medical Center decided to get out of that business, leaving the hospital without supplies and forcing it to cancel patient appointments, the Times said.

In late September, the Department of Veterans Affairs ordered its facilities to stop using the Avastin to treat the eye condition, pending further investigation.

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