Eye injections of the drug Avastin, used to treat retinal diseases, bring no greater risk of endophthalmitis, a potentially blinding eye infection, than injections with the much more expensive drug Lucentis made by the same company, according to new research from the Perelman School of Medicineat the University of Pennsylvania.Their findings are published today in JAMA Ophthalmology.

The study, based on  insurance claims data from across the United States, was conducted in response to reports of Avastin (bevacizumab)-related endophthalmitis, which led the Food and Drug Administration (FDA) recently to propose significant restrictions on use of the drug for eye conditions.

“Our analysis of a national dataset shows that the risk for endophthalmitis is no higher with Avastin and hints that there may actually be a lower endophthalmitis risk compared to Lucentis, so the proposed FDA restrictions for Avastin might have the unintended consequence of increasing the infection risk for patients,” said senior author Brian L. VanderBeek, MD, MPH, an assistant professor ofOphthalmology at Penn.

VanderBeek and his colleagues’ findings come after years of tension between eye doctors and Avastin’s maker Genentech over the drug’s ophthalmic use.

Avastin (bevacizumab) is an injectable solution of monoclonal antibodies targeted at the blood vessel growth factor VEGF. It was the first drug designed to inhibit new vessel growth (angiogenesis), and was approved by the FDA in 2004 for treating colorectal cancers—which typically boost angiogenesis to keep themselves well supplied with oxygen and nutrients.

Common age- and diabetes-related retinal diseases, such as wet macular degeneration, also result in part from VEGF-driven processes, so ophthalmologists soon began to use Avastin “off-label” to treat these conditions. Avastin as distributed for cancer treatment, is frequently repackaged by compounding pharmacies into smaller doses suitable for use in the eyes, which drives the cost of the medication down to about $50 per eye injection.

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