Positive results for Eylea in head to head study of Eylea, Avastin and Lucentis in DMO-Regeneron

A comparative effectiveness study in patients on Eylea (aflibercept ophthalmic solution), from Regeneron, for Diabetic Macular Oedema, newly published in the New England Journal of Medicine, demonstrated Eylea provides a significantly greater improvement on the primary endpoint of mean visual acuity letter score change at one year [Eylea +13 letters; bevacizumab +10; ranibizumab +11]. These differences were driven by patients with moderate or worse vision loss at the start of the trial (worse than 20/40); in these patients, Eylea showed a statistically significant 7-letter (approximately 1.5 lines on an eye chart) improvement over bevacizumab and a 5-letter (1 line on an eye chart) improvement over ranibizumab (Eylea +19 letters; bevacizumab +12; ranibizumab +14).

In the overall population, 42 percent of patients receiving Eylea gained at least 15 letters (3 lines on an eye chart) in BCVA from baseline compared to 29 percent of patients treated with bevacizumab and 32 percent of patients treated with ranibizumab. In this study, the rates of most ocular and systemic adverse events (AEs) were similar across the three study groups.

The investigators plan to present the results at the Annual Macula Society Meeting. See: "Aflibercept, Bevacizumab, or Ranibizumab for Diabetic Macular Edema" NEJM February 18, 2015DOI: 10.1056/NEJMoa1414264

Comment: Eylea offered more benefit than the Roche drugs, Avastin and Lucentis on patients with eyesight equal to or worse than 20/50, meaning they can see as well at 20 feet away as a person with perfect vision can at 50 feet.Roche’s Avastin and Lucentis performed similarly to the Regeneron drug in participants with 20/40 vision or better, according to the study of 660 people. Since outcomes were the same for the patients with mild vision loss, they should receive Avastin, which at $50 a vial is cheaper than Lucentis’s $1,200 per dose, said Daniel Martin, chairman of the Cleveland Clinic’s Cole Eye Institute, who wrote an editorial accompanying the study. Eylea, with a price priceof $1,950, should be the first-line therapy for the 25 percent of patients with worse eyesight, he concluded.