The pharmaceutical industry is nobody's favorite, and it often does things that blacken its image even further. Genetech's move regarding their monoclonal antibody Avastin® is a case in point. Ophthalmologists have been using Avastin (bevacizumab) to treat age-related macular degeneration (AMD), instead of the same company's Lucentis® (ranibizumab). Both drugs are antibodies directed against VEGF-A, a substance that promotes the formation of new blood vessels. Avastin is a larger molecule, and intended for intravenous use treating colorectal cancer, whereas Lucentis is specially formulated for injection into the eye. But ophthalmologists have found that Avastin can be used 'off-label' (meaning in a non-approved indication) for treating AMD after appropriate pharmaceutical preparation.

Of course, it all boils down to money. A shot of Lucentis costs about $2000, whereas Avastin is about $40. Dr Rosenfeld, an expert in the field, has pioneered the use of antibodies against VEGF-A in eye diseases, and has used both drugs. He and his colleagues at the Bascom Palmer Eye Institute in Miami find no difference in the effectiveness of the two drugs.

Medicare, in fact, pays 80% of the costs of Lucentis, but many secondary insurers balk at the bimonthly $400 difference. Now Genentech is making things difficult for people wanting to use Avastin instead; from November 30 they will stop supplying Avastin to compounding pharmacies that have been making the dosage form for ocular administration.

This type of behavior by pharmaceutical companies is not unknown. The replacement of one drug about to go off patent by a close, but patented, analog with virtually the same efficacy and safety allows them to ensure their high revenue stream for additional years - viz. the GERD-treatment Nexium® 'replacing' Prilosec®.