The Anti-VEGF Biosimilars Paradox | Ravi Parikh, M.D., M.P.H., ASRS 2023

© stanciuc stock.adobe.com

Biosimilars are supposed to exert some downward pressure on the costs associated with high-priced biologics. But because retinal specialists have been using repackaged, off-label Avastin (bevacizumab) as an anti-vascular endothelial growth factor (VEGF), there may be a special, somewhat ironic situation in retinal medicine that the approval of an ophthalmic version of bevacizumab will increase, not decrease, costs, according to Ravi Parikh, M.D., M.P.H.

Parikh was the corresponding author of a research paper on the biosimilars paradox published online in Ophthalmology in April 2023, and he presented findings about the unintended consequence today at the American Society of Retina Specialists annual scientific meeting in Seattle.

In an interview with Managed Healthcare Executive prior to the meeting, Parikh, a retina specialist in New York and director of healthcare delivery research for the Department of Ophthalmology at NYU Grossman School of Medicine, described the current situation of biosimilars in retinal medicine — there are two biosimilars to the Lucentis (ranibizumab) currently on the market and biosimilars to Eylea (aflibercept) are in development — and the attitudes of retinal specialists about using the lower-cost alternatives.

“There is concern or resistance to using them, but more and more retina specialists are using them. And it's important that at least they're available for retina specialist teams (to use),” said Parikh.

Parikh said that while there is always debate, there isn't any clinical evidence that Lucentis (ranibizumab) or its biosimilars are superior to off-label Avastin. He said Eylea (aflibercept) appears to be the better treatment in patients with poor vision.