Lucentis, Avastin and the treatment of age-related macular degeneration in Manitoba

Lucentis was approved by Health Canada for the treatment of age-related macular degeneration in June 2007. This is a remarkable new drug which has been shown not only to prevent progression of age-related macular degeneration, but in about 40% of patients it can actually improve vision. The result can be so dramatic that it can sometimes enable a person whose eyesight had deteriorated badly to see well enough to drive again. Improving vision, for an older person who is becoming blind is huge - and has a major benefit to increase quality of life, to decrease accidental falls etc. Yet a year and a half after being approved by Health Canada, it is not covered by pharmacare in Manitoba.

Before Christmas , when I asked the Minister of Health why it was not covered she dodged the question. She said treatment for macular degeneration is covered when a patient goes to the Misericordia Health Centre. She was referring to the fact that another drug, Avastin, which has similarities to Lucentis, is being used at the Misericordia Health Centre and is available for coverage under pharmacare, but only when used at the Misericordia Health Centre, not when used elsewhere in Manitoba. Presently, the use of avastin for treatment of age-related macular degeneration is considered "off-label" because it has not had as full or complete testing as lucentis for this purpose.

The Minister's practice with regard to the coverage of avastin and lucentis raises several questions in terms of pharmacare coverage:
1) Should pharmacare cover "off-label" drugs for treatment, rather than drugs which have been more extensively tested for side effects? If it turns out that avastin is less effective than lucentis or has more side effects than lucentis then this will put the Minister's decisions in question.
2) Should pharmacare cover drugs only when used at one facility (the Misericordia Health Centre) but not when used by ophthalmologisits at other locations? This question is a valid one - because I was approached by a resident of River Heights who came to me because he had had to pay from his own pocket for the treatment when he was treated by an opthalmologist at another centre in Manitoba.

I welcome your input. Please email me at jon.gerrard@leg.gov.mb.ca

Please note that clinical trials comparing lucentis and avastin are underway, so in due course we should know better whether Avastin is as effective as Lucentis and whether it has more or fewer side effects.

http://www.allaboutvision.com/conditions/lucentis-vs-avastin.htm

For more on this story see:

http://www.cbc.ca/health/story/2008/01/23/lucentis-hearing.html