Bevacizumab surpasses Eylea as the most common retinal disease injection | ASRS 2026

Eylea (aflibercept 2 milligrams) has been the dominant intravitreal injection for treatment of exudative age-related macular degeneration (eAMD), diabetic macular edema and other retinal conditions related to retinal blood vessels. But according to data presented at the 2026 American Society of Retina Specialists (ASRS) Annual Scientific Meeting in Montreal, off-label Avastin (bevacizumab), originally approved as a cancer drug, has surpassed Eylea.

Presenting data from the Vestrum Health database, Anton Kolomeyer, M.D., Ph.D., of NJRetina, said bevacizumab (Avastin) accounted for 29.8% of injections in 2025, up from 23.3% in 2024 and 26.4% in 2023, whereas Eylea accounted for 21.9% of injections, a sharp decrease from 36.9% in 2024 and 45.6% in 2023. Meanwhile, the use of Vabysmo (faricimab) edged up slightly, to 18.9% from 18.4% in 2024.

Asked during the question-and-answer period whether the increase in bevacizumab use was related to insurance coverage or “is it really that the retina world wants to use more Avastin?” Kolomeyer answered that the disruption of copay financial-assistance funds for brand-name retinal disease injections from the Good Days fund had affected some patients’ out-of-pocket costs.

“I keep on having conversations with [patients], and they don’t understand why they now owe something for the injection whereas before they didn’t. I never used to discuss this. I do now,” he said.

Kolomeyer said the ASRS Health Economics Committee is now studying the reasons for the shift to bevacizumab. “I don’t think it is our preference,” he said. “I think, as first line, we maybe have to [use bevacizumab] for a certain percentage of the population. You definitely have to ask yourself why the rate increased so dramatically in 2025 compared with 2023 and 2024.”

The Vestrum data presented by Kolomeyer also showed a jump in the use of Pavblu (aflibercept-ayyh), a biosimilar to Eylea, reaching 11.8% of injections in 2025, up from 0.2% in 2024.

Breaking the data down by condition, bevacizumab became the most commonly administered injection for eAMD (sometimes called wet AMD) and diabetic macular edema rather than Eylea, although Eylea remained the most commonly administered injection for retinal vein occlusion/macular edema.

Although the data Kolomeyer presented showed a decline in Eylea injections, use of the higher-dose version, Eylea HD (aflibercept 8 milligrams), climbed — accounting for 12.7% in 2025, up from 8.5% in 2024 and 0.6% in 2023.

Anticomplement jumps

Kolomeyer’s numbers also showed a large increase in the anticomplement injections used to treat geographic atrophy. In 2025, there were a total of 109,058 anticomplement injections, a 40% increase from 2024 and a 386% increase over 2023, he said. Syfovre (pegcetacoplan) accounted for 57.4% of the injections, down from 67.6% in 2024 and 94.6% in 2023.

“I think if you look at the data from the last three years the number of injections is just ever-increasing,” Kolomeyer said. “I think we are getting more comfortable with them.”

He described track records for Syfovre and the other FDA-approved anticomplement, Izervay (avacincaptad pegol), as showing that they are safe and effective, with low inflammation rates.

Approximately 15% of patients with diagnosed geographic atrophy are receiving injections. “Imagine if we just double that to 30%. We are all going to be doing way more injections,” Kolomeyer said.