Lucentis VS Avastin ในทางปฏิบัติแล้ว หมอนิยมใช้ตัวไหนมากกว่า

[VectorUK]

คือ ในด้าน Metastatic Cancer แน่นอนว่า Bevacizumab ที่มี Ind. ในการใช้ แต่เท่าที่เห็น ก็เห็นมักจะเกิดประเด็นโต้เถียงกันเรื่องการใช้รักษา Neovascular ระหว่าง Ranibizumab ซึ่งราคาแพงกว่า หรือจะใช้ Bevacizumab แบบเอามาแบ่งฉีด เพื่อลดภาระค่าใช้จ่ายให้กับผู้ป่วย

เลยอยากทราบว่า เพื่อนๆ ร่วมห้องท่านใด มีประสบการณืมาแชร์ในแง่ของการใช้ยาสองตัวนี้ของแพทย์ ในแง่ Retinal therapy บ้างครับ

ปล. ราคาสองตัวนี้ ต่างกันเยอะมากไหม แล้วช่วงนี้นโยบายกรมบัญชีกลาง มีผลอะไรกับการใช้ยาสองตัวนี้หรือเปล่าครับผม

[SinWiSuth]

The role of bevacizumab in neovascular (wet) age-related macular degeneration (AMD) continues to be investigated. The ophthalmology community is increasingly using intravitreal bevacizumab off-label in patients refractory to other treatment modalities. Intravitreal injection delivers the drug to the site of neovascularization, occurring in the retina or within the retina, while minimizing systemic exposure and interference with the normal extraocular roles of VEGF.[32671] Its use in AMD stems from anecdotal reports and has gained further acceptance after the approval of a similar compound, ranibizumab (Lucentis?). Experts note the extreme difference in therapy cost (the per dose acquisition cost of bevacizumab is approximately 1/400th that of ranibizumab) and note the positive results reported in short-term trials of bevacizumab use in AMD.[32749][32750] No guidelines are currently available for the use of bevacizumab in this population; however, published data excludes patients with a history of myocardial infarction or uncontrolled hypertension

32671. Rich RM, Rosenfeld PJ, Puliafito CA, et al. Short-term safety and efficacy of intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Retina 2006;26:495-511.

32749. Steinbrook R. The price of sight - ranibizumab, bevacizumab, and the treatment of macular degeneration. N Engl J Med 2006;355:1409-12.

32750. Rosenfeld PJ. Intravitreal Avastin: the low cost alternative to Lucentis. Am J Ophthalmol 2006;142:141-43.

ลองดู 3 เอกสารเพิ่มดูไหมครับ ??

[SinWiSuth]

For the treatment of neovascular (wet) age-related macular degeneration? (AMD):
NOTE: Prior to intravitreal injection, prepare the eye with a local anesthetic and povidone iodine and/or a broad spectrum antibiotic (see Administration).
NOTE: Following the injection, monitor patient for elevation in intraocular pressure (IOP) and endophthalmitis (see Adverse Reactions).
Intravitreous injection dosage?:
Adults and Geriatrics: 1.25 mg (0.05 ml) once a month by intravitreal injection into affected eye. Treatment continues on a monthly basis until macular edema, subretinal fluid, and/or pigment epithelial detachment is resolved.[32671] [32672] In clinical evaluation, improved visual acuity and central retinal thickness measurements were evident by week 1 of bevacizumab therapy. Improvements continued through the third month of therapy at which time the mean visual acuity improved from 20/160 to 20/125 (p < 0.001) and the mean central retinal thickness decreased by 99.6 micrometers (p < 0.001). A maximum of 4 doses were clinically evaluated.[32671]
Adolescents and Children: Safety and efficacy have not been established.

?non-FDA-approved indication

32671. Rich RM, Rosenfeld PJ, Puliafito CA, et al. Short-term safety and efficacy of intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Retina 2006;26:495-511.

32672. Avery RL, Pieramici DJ, Rabena MD, et al. Intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Ophthalmol 2006;113:363-72.

[SinWiSuth]

อ.ดร.อรัมษ์ มาดิสคัสเคส
เดี๋ยวค่ำๆ ผมมาโพสต์ฺเพิ่มอีกทีนะครับ ^ ^

[mongkon]

such the wonderful discussion!

I will keep observing this!

[VectorUK]

ขอบคุณสำหรับเอกสารเพิ่มเติมนะครับ ยังไงรอติดตามการแสดงความเห็นเพิ่มเติมนะครับผม

[SinWiSuth]

Bevacizumab ? Bevacizumab and ranibizumab are closely related antibodies. Ranibizumab is essentially an antibody fragment (Fab fragment) of bevacizumab with some modifications to the amino acid sequence that increase its binding of VEGF [32]. Bevacizumab is approved in the United States as an intravenous infusion for the systemic therapy of colorectal cancer.

Treatment with intravitreal bevacizumab is far less expensive than treatment with intravitreal ranibizumab ($50 compared to $1950 per injection) [33,34]. Pending results of large randomized trials, clinicians have used intravitreal injections of bevacizumab as a treatment for AMD [33-35]. Results from case series of intravitreal bevacizumab are promising. A prospective case series in 60 patients with wet AMD reported that patients who received intravitreal bevacizumab (2.5 mg, with repeated injection at one and two months if optical coherence tomography or visual acuity results indicated ongoing disease activity) had significant improvement in mean visual acuity at 12 months, retinal anatomic improvement, and no ocular or systemic side effects [36]. Submacular hemorrhage within three weeks of intravitreal bevacizumab was reported in 4 of 10 patients with large choroidal lesions (>15 mm) and in none of 34 patients in the same series who had smaller lesions [37].

Preliminary results from a randomized trial comparing intravitreal bevacizumab and ranibizumab find no difference in efficacy for the treatment of choroidal neovascularization in AMD [38]. In this single center trial, twenty patients completed six month follow-up. Visual acuity for the bevacizumab group went from baseline 31.6 letters to 46.4 letters and for the ranibizumab group from 30.4 to 37.4; the difference between the two groups was not statistically significant and the lesions in the bevacizumab group may have been somewhat more favorable at baseline.

A US federally-funded multicenter head-to-head randomized trial comparing bevacizumab and ranibizumab in 1200 patients with AMD is underway, with results expected in 2011 [34]. Systemic administration of anti-VEGF medications such as bevacizumab is also being studied in the treatment of AMD [39].


32. Steinbrook, R. The price of sight--ranibizumab, bevacizumab, and the treatment of macular degeneration. N Engl J Med 2006; 355:1409.
33. Rosenfeld, PJ. Intravitreal avastin: the low cost alternative to lucentis?. Am J Ophthalmol 2006; 142:141.
34. Epstein, P. Trials that matter: two faces of progress in the treatment of age-related macular degeneration. Ann Intern Med 2007; 146:532.
35. Chen CY; Wong TY; Heriot WJ. Intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration: a short-term study. Am J Ophthalmol. 2007 Mar;143(3):510-2. Epub 2006 Nov 13.
36. Bashshur ZF; Haddad ZA; Schakal A; Jaafar RF; Saab M; Noureddin BN. Intravitreal Bevacizumab for Treatment of Neovascular Age-related Macular Degeneration: A One-year Prospective Study. Am J Ophthalmol. 2008 Feb;145(2):249-256. Epub 2007 Dec 11.
37. Goverdhan SV; Lochhead J. Submacular haemorrhages after intravitreal bevacizumab for large occult choroidal neovascularisation in age-related macular degeneration. Br J Ophthalmol. 2008 Feb;92(2):210-2. Epub 2007 Oct 26.
38. Subramanian ML; Ness S; Abedi G; Ahmed E; Daly M; Feinberg E; Bhatia S; Patel P; Nguyen M; Houranieh A. Bevacizumab vs ranibizumab for age-related macular degeneration: early results of a prospective double-masked, randomized clinical trial. Am J Ophthalmol. 2009 Dec;148(6):875-82.e1. Epub 2009 Oct 2.
39. Moshfeghi AA; Rosenfeld PJ; Puliafito CA; Michels S; Marcus EN; Lenchus JD; Venkatraman AS. Systemic bevacizumab (Avastin) therapy for neovascular age-related macular degeneration: twenty-four-week results of an uncontrolled open-label clinical study. Ophthalmology. 2006 Nov;113(11):2002.e1-12. Epub 2006 Oct 5.

REF ::: UptoDate Online