On November 18, 2011, the F.D.A. approved a new medication for the treatment of neovascular age-related macular degeneration (wet AMD). This new medication, afilbercept (Eylea™), produced by Regeneron is a new weapon in the armamentarium against the blindness caused by wet AMD. Wet macular degeneration results from new blood vessels growing into the subretinal space at the direction of an antigen called vascular endothelial growth factor, or VEGF. Eylea (known as VEGF-Trap Eye) works in a slightly different way than either ranibizumab (Lucenti®) or bevacizumab (Avastin®). Both Lucentis & Avastin are antibodies that bind to VEGF, but Eylea is a mimicker of the receptor that VEGF binds to, and has a higher attraction rate for the VEGF molecules than either Lucentis or Avastin. Eylea was shown to be “non-inferior” to Lucentis in the VIEW-1 study, which also means, it was not found to be superior either.
So, what does all of this scientific talk mean for patients? In the end, it most likely represents another option for patients if they aren’t responding to their current regimen. In my practice, I start most patients on Avastin therapy. This is especially true of diabetics with macular edema, as Lucentis is not covered for these patients. If a patient fails to respond to Avastin, then I consider either a combination therapy or a change to Lucentis. With Eylea now on the market, I will have two choices. One great advantage to Eylea is that it can be dosed at 8 week intervals after a “loading period.” This will mean decreased injections and visits for some patients, and a lower burden on their insurance company.
Dr. Kori A. Elkins, Retinal Specialist