Avastin-the poor man’s drug!

Avastin (Bevacizumab) , from the day it was found to be effective in treating various eye diseases, has been a boon to many people of lower socio-economic background all over the world. Recently the drug has been put on high alert with a possibility for a ban (Not yet banned) in India for use in ocular diseases on 21 January, following a cluster of infection involving 15 patients, who had received Avastin from one particular.

Though there is an alternative to this drug, namely Lucentis, it comes with an extortionate price tag , costing at least 3-4 times more than Avastin. This move may lead to blindness due to many treatable diseases in a developing country like India where may people may not be able to afford this drug which is required to be injected multiple times.

Avastin was originally intended to be used for cancer. Manufactured by the company Roche, even till date it has been indicated and approved ONLY for the treatment of certain cancers by the company as well as FDA. On the contrary, the drug Lucentis, which is created from the same parent mouse antibody, has been approved for use in ocular diseases. The reason? Because a single vial of Avastin can be administered for ocular diseases to multiple patients due to the quantity available in a single vial (meant for cancer patients), while Lucentis comes in a single-dose vial meant only for one patient.

From a patient’s perspective, A single dose of Avastin will cost from around  ₹5000-₹10,000 . While a single dose of Lucentis may vary from ₹25,000-₹30,000. While this may not sound as much to the elite, it is a huge difference for patients who require multiple doses of the drugs over a long-period. Age-related Macular degeneration, one of the main indications for the usage of the above two drugs, typically requires a minimum of three injections in 3 months with a possibility of repeated injections to maintain the vision. I personally have patients coming to me who have received 15-20 injections to maintain their sight. It doesn’t take rocket science to calculate the cost difference.

Coming to the current issue, it is understood that people from Roche have stated that they cannot be held responsible since it has been used “off-label” ,i.e, for a disease which the drug has not been approved for. This is where the real problem lies. All the 15 patients have developed “INFECTION” and NOT ANY SIDE EFFECTS, ergo the fault is due to contamination of that particular vial and not the drug as such. So the company has to be questioned instead of trying to ban the usage of Avastin for eye diseases. Infection might have occurred if the same drug had been administered systemically which may have even resulted in death. 

Avastin has saved and maintained useful vision in so many patients, and it’s ban will only serve as a punishment for the poor who cannot afford the costlier Lucentis multiple times. While even in economically rich countries like the USA, where the majority of the Doctors prefer Avastin over Lucentis, a nation like India with majority of the people falling under lower and middle-class category, a ban on Avastin is somthing to be taken seriously by not only the Doctors, but the general public also.

It is high time the FDA revises its decision on the usage of Avastin. And hopefully the drug controller of India does not impose a ban on the use of Avastin for ocular diseases.

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