new drug-Avastin for ROP

[babyNP.]

Has anyone heard about this new drug? I learned about it on a review course. It was a cancer drug that helps stop the formation of new blood vessels, I guess. Recently it's been under studies with the FDA for approval for ROP in babies and I guess it worked so well (decreasing incidence of laser surgery) that they're stopping the study early.

Talked to a few of our docs on the unit and I guess they just attended a webinar about it.

Anyone else heard about this? Anyone else using it? I guess it involves sticking needles in the baby's eyes, eep! I suppose the opthamologists will be doing that job

[EricJRN, MSN, RN]

I was shocked when I found out how inexpensive Avastin was for ROP. High cost is actually usually described as a disadvantage for monoclonal antibodies (Synagis is one example). And in cancer therapy, Avastin itself is usually ridiculously expensive (common to see costs cited between $50,000 and $100,000 per year).

I'm guessing that the lower cost for ROP is related to a much lower dose that doesn't require repeated administration.

[caroladybelle, BSN, RN]

It is wretchedly expensive, and unreimbursed/underreimbursed by most insurances for cancer treatment. And for many cancer pts, unavailable for that reason.

I suspect that the intraocular doses for babies are much smaller .....or subsidized

[TiffyRN, BSN, PhD]

I did a quick google search and found the ADULT dose for intravitreal injection was something like 1.25 to 2.5mg, one article I couldn't get to pull up mentioned a dose of 0.4mg for ROP.

Epocrates listed dosages for cancer treatment and they varied from 5-15mg/kg every 2 to 3 weeks or so.

So a 75kg adult would need 375 to 1125mg every two weeks, that has to be so much more expensive. Infant ROP dosages could be derived from the overfill they send in the syringes (or bags, I don't know what they use).

[babyNP., APRN]

Just as a quick update, I recently talked to my eye doctor about Avastin. She sees post-ROP kids and does contract work with adults on the side.

Anyway, she told me that it was highly experimental and she doesn't know any of the major hospitals on the eastern seaboard that are doing it right now. She's pretty wary about it, which surprised me given all the good that I've heard about it. But I suppose with medicine's history of being oblivious to long-term outcomes and ethical dilemmas (re: Tuskeegee), I can understand her hesitation...definitely I'm going to try to read more about it.

[NeoNurseTX, RN]

Just as a quick update, I recently talked to my eye doctor about Avastin. She sees post-ROP kids and does contract work with adults on the side.

Anyway, she told me that it was highly experimental and she doesn't know any of the major hospitals on the eastern seaboard that are doing it right now. She's pretty wary about it, which surprised me given all the good that I've heard about it. But I suppose with medicine's history of being oblivious to long-term outcomes and ethical dilemmas (re: Tuskeegee), I can understand her hesitation...definitely I'm going to try to read more about it.

Our doc has an article in the Feb issue of the New England JoM. Copies are floating around our unit and it seemed the Avastin group's outcomes were statistically significant better when given in..I don't remember what stage of ROP... than laser surgery.

[NicuGal, MSN, RN]

Are you guys seeing the insurance companies reimbursing it? None of the Big 3 in our area are using it and don't forsee using it anytime soon