Age-related macular degeneration, or AMD, is the most common cause of vision loss in the elderly. Among the two types of AMD, namely the wet AMD and dry AMD, the former is more severe. Lucentis (ranibizumab), developed by Roche unit Genentech is the gold standard for treating wet AMD. Another drug - Avastin, indicated for various cancers, from the stables of the same company is also commonly used off-label to treat wet AMD. Swiss drugmaker Novartis AG (NVS) has exclusive rights on Lucentis outside the U.S.
In what is perhaps one of the largest trials ever carried out in the field of eye disease in the UK, which compared Avastin and Lucentis head to head, scientists have found that the two treatments are equally effective in treating wet AMD.
The study dubbed IVAN involved 610 people with wet AMD in 23 hospitals who were randomized to receive one of the two drugs namely, Avastin and Lucentis. Patients received three monthly injections of the drug in the affected eye, and they were then subdivided to receive either injections at every visit thereafter or if the condition worsened.
According to the study results, "there was no functional difference in the effects of both drugs and that their effects on preventing vision loss were similar".
The one year results of the IVAN study have also revealed that giving the drugs as needed, compared to regularly every month, resulted in almost identical levels of vision. The 'as needed' group received on average seven injections over the first year compared to 12 for the monthly treatment group.
Since the study period is 2 years, the IVAN trial is continuing to follow participants. A more detailed analysis will be presented on completing the two year time point.
The study also indicates that the healthcare system in the U.K. could save 84.5 million pounds annually by switching from Lucentis to Avastin, and administering the treatment on an 'as-needed' basis.
Note that the cost of Lucentis is about 700 pounds per injection while Avastin costs about 60 pounds per injection.
As regards the safety of the two drugs, there was a slightly higher rate of arteriothromboembolic events (mainly heart attacks and strokes) or heart failure among people treated with Lucentis compared with Avastin in the IVAN study. However, when the data was combined with another head-to-head study, dubbed CATT, conducted in the United States, there was no difference in heart attacks or strokes between the two drugs.
The findings of the trial were welcomed by the Macular Disease Society. However, its Chief Executive Helen Jackman, said, "The trials cannot provide definitive safety information and the overall question of the safety of Avastin is, unfortunately, not answered to everyone's satisfaction by these trials. The use of Avastin will remain a matter of judgment for clinicians with some satisfied with the evidence and others not."
The Macular Disease Society has also reiterated that the government needs to conduct an independent appraisal of Avastin for use in ophthalmology.
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