Eyelea is Shown to Be More Effective Than Avastin at Weaning nvAMD Patients off Treatments

The early response to neovascular age-related macular degeneration (nvAMD) treatment with aflibercept (Eyelea) was much greater than the response to bevacizumab (Avastin), in hopes of weaning those affected off the therapies sooner.

According to a recent study published in the Journal of Clinical Investigation, researchers of Johns Hopkins Medicine examined whether the choice of therapy for nvAMD influenced the outcomes of a treat-and-extend-pause/monitor (TEP/M) approach, which can in fact wean 31% of nvAMD patients off anti-VEGF therapies like Eyelea and Avastin.

The (TEP/M) approach was previously monitored and studied by Johns Hopkins.

Researchers stated aflibercept and bevacizumab are the two most frequently used therapies for the treatment of nvAMD. Aflibercept has previously been shown to have a longer treatment time period and may be more effective than bevacizumab for the treatment of some patients with nvAMD. However, both anti-VEGF therapies raise concerns about the economic and social burden of frequent clinic visits for elderly patients.

Age-related macular degeneration is the most common cause of vision loss among people age 50 and older, affecting an estimated 7.3 million individuals in the U.S.. About 1.75 million of these patients have advanced AMD will lose vision from this condition. This includes patients with the “wet” form of AMD, which is the growth of abnormal blood vessels in the retina that can bleed or leak damaging fluids into the central portion of this light-sensing tissue.

In this retrospective study, 122 eyes of 106 patients with nvAMD underwent 3 consecutive monthly injections with either aflibercept (70) or bevacizumab (52) followed by the TEP/M method. Eyes that remained stable 12 weeks from their prior treatment were given a 6-week trial of holding further treatment, followed by quarterly monitoring. Treatment remained for those whose vision got worse, needed a clinical exam, or had further OCT findings.

At the end of year one, eyes receiving bevacizumab had similar vision but required more injections compared to those who received aflibercept. Patients treated with aflibercept were almost 3-times more likely to be weaned off treatment (43% vs. 15%) compared to eyes treated with bevacizumab at the end of one year.

“Our results suggest that if we can match the right patient to the best therapy, many patients with macular degeneration may not need lifelong therapy,” said Akrit Sodhi , M.D., Ph.D., associate professor of ophthalmology and the Branna and Irving Sisenwein Professor in Ophthalmology at the Wilmer Eye Institute at the Johns Hopkins University School of Medicine, in a release by Johns Hopkins.

Sodhi, co-author of the study, commented further to the results of the study and said many prior studies have suggested a very modest benefit for Eylea over Avastin.

"Our study suggests that there may be an additional benefit, at least for those patients being treated using a treat-and-extend, pause and monitor approach (i.e., if the goal is to wean patients off treatment,)" he added.

"However, it is important to acknowledge that our study was a retrospective, single center, non-randomized, non-blinded study. The results are very intriguing, to be sure. But the extent to which Eylea is superior to Avastin for weaning patients off therapy requires confirmation with a prospective randomized clinical trial."

Although, whether these outcomes suggest that off-label use of bevacizumab is an option, it is one that arises.

Sodhi said off-label use of bevacizumab remains the most cost-effective approach for the treatment of nvAMD. However, based on the study it requires more frequent treatments and may be less effective at weaning patients off therapy.

According to the Johns Hopkins release, Aflibercept and bevacizumab use for the treatment of wet AMD shows the interval between treatments for aflibercept (approximately $2,000 per treatment) is longer, and that aflibercept may be more effective than bevacizumab (approximately $100 per treatment). However, at more than 10 times the cost of monthly bevacizumab, whether this small benefit justifies the additional expense of bimonthly, aflibercept remains under debate among clinicians.