The potential off-label use of Avastin for wet age-related macular degeneration has been a source of many arguments over the last few years. The arguments come because another formulation of the same drug, Lucentis, is what’s actually approved for wet AMD, and it’s significantly more expensive. (The two forms appear to have basically the same activity, as determined in a clinical trial that was not looked upon favorably at all by the compounds’ manufacturers and marketers, Roche and Novartis). This has led to a lot of off-label use, and a lot of talk among physicians in various countries about how best to do this.
Now a reader sends word that the government of France has come right out and said it: prescribe Avastin off-label, because Lucentis is equivalent and it’s too costly. This had been tried as a temporary measure earlier this year, to Roche’s displeasure, and now it’s official policy. Lucentis has been a significant expense for the state health service, and the government is striking back with the weapon they have to hand. Expect more of this, especially if companies try to maintain positions like this one. From my perspective, this is a price/efficacy battle that was lost some time ago, and trying to hold on to it just invites this kind of response.