Central Retinal Vein Occlusion Drugs Comparable Despite Price Difference

No difference in safety or efficacy between bevacizumab (Avastin) and aflibercept (Eylea).

Results from a new study found that bevacizumab (Avastin) is comparable in efficacy to afilbercept (Eylea) for the treatment of central retinal vein occlusion (CRVO). While the drugs had similar effects, bevacizumab is significantly less expensive and may be a cost-effective alternative to aflibercept.

The authors discovered that after only 6 treatments of monthly injections, patients taking either drug had improved visual acuity, with an average improvement of 20/100 to 20/40, according to the study published by the Journal of the American Medical Association.

“This head-to-head comparison of 2 widely used drugs for treatment of macular edema due to central retinal vein occlusion shows that both are effective in improving vision,” said chair of the study Ingrid U. Scott, MD, MPH, professor of ophthalmology and public health sciences at Penn State University. “The bottom line is that in patients with CRVO-associated macular edema, Avastin was as effective as Eylea in terms of visual acuity after 6 months of treatment.”

Retinal vein occlusion is a common retinal vascular disease that affects millions of adults around the world. CRVO occurs when the central vein that carries blood away from the retina becomes blocked and prevents oxygen from reaching the tissue, according to the study. This results in a release of vascular endothelial growth factor (VEGF).

The release of VEGF leads to swelling in the retina (macular edema), which is the most common cause of vision loss related to CRVO.

Aflibercept is indicated to treat CRVO-associated macular edema and costs $1850 per dose. Bevacizumab is indicated to treat cancer, but is prescribed off-label to treat eye diseases, and only costs $60 per dose. Both drugs are anti-VEGF treatments, which reduces the leakiness of injured blood vessels.

In the Study of COmparative Treatments for REtinal Vein Occlusion 2 (SCORE2), the authors compared the safety and efficacy of both drugs to determine which would be the optimal therapy.

Included in the study were 362 patients with CRVO-associated macular edema who were randomized to receive aflibercept 2-mg or bevacizumab 1.25-mg through intraocular injection once every 4 weeks for 6 months. The authors evaluated visual acuity, retinal thickness, and side effects at 6 months.

The authors discovered that both groups showed marked improvements in visual acuity, with an average increase of approximately 4 lines on an eye chart, according to the study.

“This is a remarkable improvement in vision,” said Frederick Ferris, MD, director of the Division of Epidemiology and Clinical Applications at National Eye Institute (NEI). “On average, it more than doubles the ability to resolve fine detail, and for some patients it restores their ability to drive.”

Through optical coherence tomography (OCT), the authors discovered that macular edema was reduced in both treatment groups. The authors found that 54% of patients treated with aflibercept had complete resolution of macular edema, while only 29% of patients treated with bevacizumab had complete resolution of the condition, according to the study.

However, the authors noted that the lower proportion of resolved macular edema did not translate to poorer vision at 6 months. In the future, the authors plan to continue studying the effects of long-term treatment and how residual edema may affect patients.

“There is little information about the long-term treatment needs of patients with CRVO-associated macular edema,” Dr Scott said. “The clinical trials that were conducted for the approval of Eylea for CRVO-associated macular edema were relatively short-term, and there have been reports of patients with CRVO requiring treatment several years out. There is important additional information that can be gained with longer follow-up of SCORE2 participants.”

At 6 months, the authors discovered that adverse events — such as elevated intraocular pressure – were similar in both groups, with neither experiencing a substantial amount.

“SCORE2 results provide invaluable data to guide clinicians and their patients toward informed decisions about CRVO treatment,” said Sangeeta Bhargava, PhD, program director at NEI.