| Clinical, legal and ethical implications of the intra-ocular (off-label) use of bevacizumab (avastin)--a South African perspective. | |
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MedLine Citation:
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PMID: 19736847 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Choroidal neovascularisation is a potentially visually devastating element of various forms of eye pathology. Recent research has focused on neurovascular age-related macular degeneration (AMD) as a cause. AMD can be classified as being exudative (wet) or atrophic (dry). Wet AMD is characterised by a pathological process in which new blood vessels develop in the choroids, causing leakage of fluid and haemorrhage under the retina and leading to localised serous detachment and loss of central vision. Vascular endothelial growth factor (VEGF) stimulates growth of neovascular membranes. Treatments have until recently yielded disappointing results. Ophthalmologists are using intra-ocular injections of bevacizumab (Avastin), an anti-VEGF, to treat AMD. Avastin appears to be safe and effective in the short term, but its intra-ocular administration is entirely off-label. Avastin is registered for treating metastatic colorectal and breast cancer. The off-label use of medication is an important part of mainstream, legitimate medical practice worldwide. Lawyers representing plaintiffs injured by drugs increasingly encounter off-label use claims. From a legal/ethical point of view the off-label use of medication represents a delicate balance between the statutory regulation of medication and a physician's prerogative to prescribe medication that in his or her medical opinion will be beneficial to the patient. The main reason for the controversy created by the off-label use of Avastin is that there are anti-VEGF drugs on the market that have formal approval for the treatment of AMD (and other eye conditions). Lucentis, for example, is extremely expensive, with treatment cost approximately 50 times that of Avastin. Many patients suffering from AMD and macular oedema cannot afford the registered product. The off-label use of Avastin has passed the innovative or experimental stages, as ophthalmologists have used it regularly and openly for a long time, with good success. Such use therefore cannot be considered careless, imprudent or unprofessional. We submit that an ophthalmologist who omits to inform a patient of the availability of Avastin for this form of treatment may be found to be negligent. Protocols developed by the South African Vitreoretinal Society and endorsed by the Ophthalmological Society of South Africa for administering Avastin and other intra-ocular medication intravitreally should be strictly adhered to. |
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Authors:
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Rita-Mari?? Jansen; Chris Gouws |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde Volume: 99 ISSN: 0256-9574 ISO Abbreviation: S. Afr. Med. J. Publication Date: 2009 Jun |
Date Detail:
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Created Date: 2009-09-09 Completed Date: 2009-09-23 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0404520 Medline TA: S Afr Med J Country: South Africa |
Other Details:
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Languages: eng Pagination: 446-9 Citation Subset: IM |
Affiliation:
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Department of Private Law, University of the Free State, Bloemfontein. Jansenr.rd@ufs.ac.za |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angiogenesis Inhibitors
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administration & dosage* Antibodies, Monoclonal / administration & dosage* Choroidal Neovascularization / drug therapy* Drug Labeling* Ethics, Medical* Eye Humans Informed Consent Injections Malpractice Vascular Endothelial Growth Factor A / antagonists & inhibitors |
| Chemical | |
Reg. No./Substance:
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0/Angiogenesis Inhibitors; 0/Antibodies, Monoclonal; 0/Vascular Endothelial Growth Factor A; 0/bevacizumab |
| Comments/Corrections | |
Comment In:
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S Afr Med J. 2009 Jun;99(6):438-9
[PMID:
19736843
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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