NIH-sponsored Trial Finds EYLEA® (aflibercept) Injection Reduced Vision-threatening Complications by 68% after Two Years in Diabetic Retinopathy Patients
Protocol W trial data confirm results from PANORAMA trial showing EYLEA significantly reduced vision-threatening complications and improved anatomic measures of diabetic retinopathy
Although patients' overall vision was similar in the EYLEA and sham groups at two years in Protocol W, a new analysis from PANORAMA shows that delaying EYLEA treatment (sham group) was associated with prolonged periods of vision loss
Two diabetic retinopathy trials (Protocol W and PANORAMA) have now shown the benefit of EYLEA every 16 weeks following an initial dosing period; Regeneron to discuss 16-week dosing interval with
Although at the two-year time point of Protocol W, preventive EYLEA treatment did not confer a significant difference in visual acuity versus delayed EYLEA treatment following vision-threatening complications (i.e., sham), a recent Regeneron follow-up analysis in the similarly designed PANORAMA trial found that delaying EYLEA treatment resulted in three times as many patients suffering prolonged vision loss, compared to those receiving preventive EYLEA treatment, during a two-year period. A similar analysis has not yet been conducted for Protocol W.
"Blindness is one of the most feared consequences of diabetic retinopathy, and we thank the
In Protocol W, patients were randomly assigned to receive either EYLEA (2 mg, n=200 eyes) every 16 weeks, after receiving four initial doses at weeks 0, 4, 8 and 16, or sham (n=199 eyes). Patients had excellent vision when they entered the trial, with more than three-quarters of eyes having 20/20 visual acuity or better (78% EYLEA, 81% sham). Rescue therapy (primarily EYLEA) was administered to patients if they developed either PDR or CI-DME.
Compared to sham, EYLEA-treated patients were:
- 68% less likely to develop CI-DME with vision loss or PDR, the primary outcome measure at two years (p<0.001).
- The cumulative probability of developing PDR or CI-DME with vision loss was 16% with EYLEA versus 44% with sham. EYLEA patients were 66% less likely to develop PDR (p<0.001) and 64% less likely to develop CI-DME with vision loss (p=0.002).
- Three times more likely to experience at least a two-step improvement in their DR severity score (DRSS). In total, 69 (45%) EYLEA patients experienced at least a two-step improvement, versus 22 (14%) of those in the sham group (adjusted odds ratio [OR]: 5.91; p<0.001).
- Five times less likely to require rescue therapy with EYLEA due to PDR or DME (4% EYLEA, 19% sham). Other rescue treatments were panretinal photocoagulation (PRP) (<1% EYLEA, 2% sham), vitrectomy for PDR (<1% EYLEA, <1% sham) and focal/grid laser treatment for DME (0% EYLEA, 2% sham).
In the retrospective PANORAMA analysis of vision outcomes over two years, three times more patients in the sham group suffered from prolonged vision loss (range: 6 weeks to 6 months), compared to the EYLEA every-16-weeks dosing group (12 of 135 EYLEA, 38 of 133 sham). Results by loss of letters were as follows (as measured by the Early Treatment Diabetic Retinopathy Study [ETDRS] chart):
- ≥5 letter loss: 9% EYLEA versus 29% sham, nominal p<0.0001.
- ≥10 letter loss: 5% EYLEA versus 14% sham, nominal p=0.0212.
- ≥15 letter loss: 3% EYLEA versus 8% sham, nominal p=0.0672.
No new safety signals were identified in Protocol W, consistent with the known safety profile of EYLEA. Ocular adverse events (AEs) included endophthalmitis (n=3 EYLEA, n=0 sham). The rate of any cardiovascular/cerebrovascular AEs was not significantly different among the treatment groups (9% of patients treated with EYLEA in one eye, 9% of patients treated with sham in one eye, and 8% of patients treated with both EYLEA [one eye] and sham [other eye]).
"Diabetic retinopathy is the leading cause of blindness among working adults. However, vision loss is often preventable if proactive measures are taken by patients and their doctors," said
EYLEA is the only vascular endothelial growth factor (VEGF) inhibitor that is
About Protocol W
Protocol W is a four-year, randomized, multi-center, controlled Phase 3 trial (n=399 eyes) designed to determine the efficacy of EYLEA compared to sham in preventing vision-threatening complications in high risk patients. The primary outcome at two years was time to development of CI-DME with vision loss or PDR. Key secondary outcomes included development of any PDR or DME criteria based on reading center assessment, as well as development of CI-DME with a ≥10% and ≥25 micron increase in center subfield thickness. Per the trial protocol, Protocol W will continue for another two years, when the second primary outcome will assess visual acuity outcomes between the two groups at four years.
The Clinicaltrials.gov identifier for this trial is NCT02634333. The trial was supported by the
About Diabetic Retinopathy
Approximately eight million people live with diabetic retinopathy, a disease characterized by microvascular damage to the blood vessels in the retina often caused by poor blood sugar control in people with diabetes. The disease generally starts as NPDR and often has no warning signs or symptoms. NPDR may progress to PDR, a stage of the disease in which abnormal blood vessels grow onto the surface of the retina and into the vitreous cavity, potentially causing severe vision loss. DME can occur at any stage of DR as the blood vessels in the retina become increasingly fragile and leak fluid, potentially causing visual impairment. In the
About EYLEA® (aflibercept) Injection
EYLEA® (aflibercept) Injection is a VEGF inhibitor formulated as an injection for the eye. It is designed to block the growth of new blood vessels and decrease the ability of fluid to pass through blood vessels (vascular permeability) in the eye by blocking VEGF-A and placental growth factor (PLGF), two growth factors involved in angiogenesis. In the
IMPORTANT SAFETY INFORMATION FOR EYLEA® (aflibercept) INJECTION
- EYLEA®(aflibercept) Injection is contraindicated in patients with ocular or periocular infections, active intraocular inflammation, or known hypersensitivity to aflibercept or to any of the excipients in EYLEA.
- Intravitreal injections, including those with EYLEA, have been associated with endophthalmitis and retinal detachments. Proper aseptic injection technique must always be used when administering EYLEA. Patients should be instructed to report any symptoms suggestive of endophthalmitis or retinal detachment without delay and should be managed appropriately. Intraocular inflammation has been reported with the use of EYLEA.
- Acute increases in intraocular pressure have been seen within 60 minutes of intravitreal injection, including with EYLEA. Sustained increases in intraocular pressure have also been reported after repeated intravitreal dosing with VEGF inhibitors. Intraocular pressure and the perfusion of the optic nerve head should be monitored and managed appropriately.
- There is a potential risk of arterial thromboembolic events (ATEs) following intravitreal use of VEGF inhibitors, including EYLEA. ATEs are defined as nonfatal stroke, nonfatal myocardial infarction, or vascular death (including deaths of unknown cause). The incidence of reported thromboembolic events in wet AMD studies during the first year was 1.8% (32 out of 1824) in the combined group of patients treated with EYLEA compared with 1.5% (9 out of 595) in patients treated with ranibizumab; through 96 weeks, the incidence was 3.3% (60 out of 1824) in the EYLEA group compared with 3.2% (19 out of 595) in the ranibizumab group. The incidence in the DME studies from baseline to week 52 was 3.3% (19 out of 578) in the combined group of patients treated with EYLEA compared with 2.8% (8 out of 287) in the control group; from baseline to week 100, the incidence was 6.4% (37 out of 578) in the combined group of patients treated with EYLEA compared with 4.2% (12 out of 287) in the control group. There were no reported thromboembolic events in the patients treated with EYLEA in the first six months of the RVO studies.
- Serious adverse reactions related to the injection procedure have occurred in <0.1% of intravitreal injections with EYLEA including endophthalmitis and retinal detachment.
- The most common adverse reactions (≥5%) reported in patients receiving EYLEA were conjunctival hemorrhage, eye pain, cataract, vitreous detachment, vitreous floaters, and intraocular pressure increased.
EYLEA® (aflibercept) Injection 2 mg (0.05 mL) is indicated for the treatment of patients with Neovascular (Wet) Age-related Macular Degeneration (AMD), Macular Edema following Retinal Vein Occlusion (RVO), Diabetic Macular Edema (DME), and Diabetic Retinopathy (DR).
DOSAGE AND ADMINISTRATION
Diabetic Macular Edema (DME) and Diabetic Retinopathy (DR)
- The recommended dose for EYLEA is 2 mg (0.05 mL) administered by intravitreal injection every 4 weeks (approximately every 28 days, monthly) for the first 5 injections followed by 2 mg (0.05 mL) via intravitreal injection once every 8 weeks (2 months).
- Although EYLEA may be dosed as frequently as 2 mg every 4 weeks (approximately every 25 days, monthly), additional efficacy was not demonstrated in most patients when EYLEA was dosed every 4 weeks compared to every 8 weeks. Some patients may need every 4 week (monthly) dosing after the first 20 weeks (5 months).
Neovascular (Wet) Age-Related Macular Degeneration (AMD)
- The recommended dose for EYLEA is 2 mg (0.05 mL) administered by intravitreal injection every 4 weeks (approximately every 28 days, monthly) for the first 3 months, followed by 2 mg (0.05 mL) via intravitreal injection once every 8 weeks (2 months).
- Although EYLEA may be dosed as frequently as 2 mg every 4 weeks (approximately every 25 days, monthly), additional efficacy was not demonstrated in most patients when EYLEA was dosed every 4 weeks compared to every 8 weeks. Some patients may need every 4 week (monthly) dosing after the first 12 weeks (3 months).
- Although not as effective as the recommended every 8 week dosing regimen, patients may also be treated with one dose every 12 weeks after one year of effective therapy. Patients should be assessed regularly.
Macular Edema Following Retinal Vein Occlusion (RVO)
- The recommended dose for EYLEA is 2 mg (0.05 mL) administered by intravitreal injection once every 4 weeks (approximately every 25 days, monthly).
For more information, please see full Prescribing Information.
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