I find it hard to see how VEGF-Trap-Eye can effectively compete with off-label Avastin
Well the first issue is how well it can compete with Lucentis. Basically comparable efficacy, but once every two months instead of once a month is a significant advantage. I am sure injections into the eye cannot be pleasant, aside from the cost and hassle of 12 trips a year to the doctor instead of 6.
Lucentis does about $3 billion annually world-wide, so having an advantage over Lucentis is not trivial.
Further, it's easy to justify Avastin vs Lucentis given comparable efficiency and the cost-savings. It becomes a bit harder when you have to tell the patient that the cheaper drug requires twice as many injections.
Next year, data from the National Eye Institute Lucentis-Avastin Trial ( http://clinicaltrials.gov/ct2/show/NCT00593450 ), should increase Avastin's 65% share of US procedures for wet AMD.