A specialist wants to give Mom Lucentis injections. Is this wise since she had a stroke and has pacemaker? - AgingCare.com

A specialist wants to give Mom Lucentis injections. Is this wise since she had a stroke and has pacemaker?


My Mom is 83 and has macular degeneration. She sees pretty well since she had cataract surgery.
Don't want to chance her having another stroke, which can happen if she has the Lucentis injections

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You are right to be concerned and you should talk it over with her doctor. The rate of stroke and heart attack with Lucentis is about the rate that would be expected for people in that age group. However, it IS higher in those who have had a previous stroke. It's a difficult decision, since Lucentis is very effective in slowing or halting the progression of age-related macular degeneration. I would absolutely opt for Lucentis injections if I had AMD. The alternative is a fast loss of central vision and legal blindness within 5 years or sooner.

Avastin has a similar safety profile, though it is being given "off-label".

The comments regarding profit are not based on fact. Retinal specialists charge for these drugs because they have to pay for them first! In fact, the reimbursement level for Lucentis has a lower profit margin for the doctor. Although the Avastin costs the doctor less, the mark-up is more. So the physician actually realizes more dollars per injection with Avastin. It's actually more complicated than that, but there is little incentive to prescribe Lucentis over Avastin.

At last week's Retina meeting, a survey of specialists showed that 59% of them use Avastin as the first choice of treatment.
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I'd say go for it, sooner the better. My father also had "wet" macular degeneration, and a pacemaker, and stroke damage. Studies show Lucentis can sometimes be a miracle drug at slowing (not reversing) macular degeneration. (Unfortunately it had no impact in my father's case.) It didn't impact him negatively in terms of his pacemaker or prior stroke. It was just a waste of time and money, but his sight was quite far gone before they started. By the way, Genentech makes another drug (Avastin) that works just as well as Lucentis and is cheaper in terms of co-pays and costs to Medicare. The doctor must obtain it from a clean, reputable compounding pharmacy which splits it into small doses. (There was a rash of problems with infections some years ago, but that's not inherent to the drug, it was a problem with the compounding pharmacy. ) Unfortunately the doctor doesn't get paid as well when he uses Avastin (he gets paid a 4.3% markup on the price of any drug he administers. Lucentis costs $2,000 a dose, Avastin only about $50, so do the math.) One of the wierdnesses in Medicare reimbursement due to the powerful pharmaceutical lobby.
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After reading the adverse events reports on Lucentis, I would not let anyone use this on me or anyone I cared about.
Just remember there is a certain profit motivation on the MD's part.
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From my search online it seems that blood clots and stroke are a rather rare and extreme side effect. I wish something like this would have been available 20 years ago when my mom discovered she had wet AMD. One day she had a bleed that destroyed the vision in one eye, and the gradual vision loss in her other eye robbed her of her independence. I'm sure that her impaired vision has contributed to her cognitive decline. I haven't kept up on the newer treatments available, if she doesn't have the shots what are her other options?
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