In treating AMD, choices are complicated…and dangerous

Blind leading

It’s one of the most common–and most feared–diagnoses that comes as we get older…age-related macular degeneration (AMD). And it’s especially scary because it’s the leading cause of blindness in seniors.

The good news is that, unlike so many other diseases we face, there are treatments for this one. In fact, most AMD patients are offered one of two drugs.

The first costs $50 per dose, and the other costs (no kidding) $2,000 per dose.

Easy decision? On the surface, sure. But there’s much more going on here than a $1,950 price difference.

Between a rock and a hard place

The pricy drug is Lucentis, which is specifically designed to treat AMD.

The less expensive drug is Avastin, a cancer drug that eye doctors have been using off- label for several years as an AMD treatment.

In a recent study, patients were treated with one of the two drugs for a year. At the end of the year, Avastin patients were able to read, on average, 8 additional letters on an eye chart, while Lucentis patients were able to read 8.5 additional letters.

As a New England Journal of Medicine editorial put it, health care providers will now have to justify the cost of using Lucentis.

No doubt they will–or already have.

But once we add side effects to the equation, the choice gets even trickier.

According to the Lucentis website, some patients who use the drug have had detached retinas and serious infections inside the eye. Other risks include “eye- and non-eye- related blood clots (heart attacks, strokes, and death).”

The list goes on to include eye pain, small specks in vision, headaches, and respiratory infections. Like many powerful drugs, the side effects range from ordinary to horrifying.

That’s what you get for $2,000 per dose.

For $50 per dose with Avastin, you get a list of potential side effects that reads like interrogation techniques from the Spanish Inquisition: Stroke or heart problems (which can be fatal), serious kidney problems (which can also be fatal), high blood pressure, difficulty breathing, tremors, nose bleeds, back pain, inflammation of the skin, and nervous system and vision disturbances (which can include seizure and blindness).

These side effects were seen in cancer patients treated with Avastin, so we can’t be certain the same dangers would be present for patients using the drug, off label, for AMD. But in a recent AMD study (even more recent than the NEJM study mentioned above), Avastin increased risk of early death by 11 percent and risk of hemorrhagic stroke by nearly 60 percent compared to Lucentis.

Going back to our drawing board

Of course, in neither of these studies, and in none of the reports I read about the studies, does anyone mention that there’s a natural medicine alternative that’s completely free of side effects. And $2,000 will probably buy you a lifetime supply.

Years ago I first told you about the Age-Related Eye Disease Study (AREDS)–an ongoing clinical trial sponsored by the National Eye Institute. AREDS has shown that vitamins C and E, beta-carotene, zinc, and copper, taken together, can help prevent AMD.

Over time, researchers began calling this combination of nutrients the “AREDS formula,” which is now being used as an AMD treatment.

The website for Macular Degeneration Research (a program of the American Health Assistance Foundation) states that the AREDS formula “may delay or prevent intermediate age-related macular degeneration from progressing to the advanced stage.”

So which would you rather try first: Lucentis, Avastin, or the AREDS formula?

For those of you who picked option number three (good choice!), here are the exact daily dosages used in AREDS:

• Vitamin C–500 mg
• Vitamin E–400 IU
• Beta-carotene–15 mg
• Zinc (as zinc oxide)–80 mg
• Copper (as cupric oxide)–2 mg

You can also look for similar formulas that include two vision-friendly carotenoids that I’ve also mentioned many times: lutein and zeaxanthin.

Sources:
“Cheap Drug Beats Pricey One In Treating Vision Loss In Elderly” April Fulton, NPR, 4/29/11, npr.org
“Roche’s Avastin Boosts Risks For Eye Patients, Analysis Finds” Dermot Doherty, Bloomberg, 5/4/11, Bloomberg.com
“Macular Degeneration Risk Factors and Prevention” Macular Degeneration Research, ahaf.org