Yes, because the available evidence shows that it is as good but at 1–2% of the price! The two drugs are ‘almost identical’.1 Both owned by the same company—Roche/Genentech, the main difference is that one is highly profitable for treating AMD, the other not. Unless and until the main head-to-head trials,1, 2 currently recruiting, report to the contrary, avastin should be preferred.

The evidence for avastin versus lucentis is weak for one very simple reason: the company refused to license it. Whether this was because of cock-up or conspiracy does not matter. Cock-up in that Roche/Genentech may not have realised it would work in humans. Or the conspiracy in that once avastin was licensed in high doses for colorectal cancer, the cost of the small doses for AMD was going to be low. Either way, avastin has not been properly trialled for AMD. This is why publicly funded trials are now in progress, due to report around 2010/11. In the meantime, clinicians and funders must decide which drug to use.

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