Use of Low-Dose Eylea Grows for Diabetes-Related Eye Conditions | AAO 2024

Patients with diabetic eye conditions who have Medicare Part B and Medicare Advantage are more likely to receive injections for Eylea (aflibercept) 2 mg compared with bevacizumab, a pattern not seen with patients in commercial insurance, according to a poster at the annual meeting of the American Academy of Ophthalmology (AAO), taking place this weekend in Chicago.

Treatments for patients with retinal vascular occlusions and wet macular degeneration focus on vascular endothelial growth factor (VEGF), which is believed to play a significant role in the abnormal formation of blood vessels in the macula. Current anti-VEGF therapies require repeat treatments, with some dosed every month with intravitreal injections, where the therapy is delivered to the back of the eye.

Several anti-VEGF drugs are available, including Regeneron’s Eylea both in 2 mg and a high-dose 8 mg that was approved in 2023; Genentech’s Lucentis (ranibizumab); Genentech’s Vabysmo (faricimab-svoa); and Novartis’ Beovu (brolucizumab). Additionally, the anti-cancer drug Avastin (bevacizumab) is used off-label because it inhibits the growth of blood vessels.

Two biosimilars of ranibizumab are also available, including Byooviz and Cimerli. In addition, this year, two biosimilars of Eylea were approved (Yesafili and Opuviz), but these were not included in the study presented at AAO.

Joseph R. Colcombe, M.D.

Joseph R. Colcombe, M.D., an ophthalmology resident at NYU Langone Health and his colleagues conducted a retrospective observational study using the Epic Cosmos Database for records related to the CPT 67028 (intravitreal injection) from Jan. 1, 2017, to Dec. 31, 2023. They grouped visits into four categories: retinal vascular occlusions, wet macular degeneration, diabetic eye disease, and other. These were assessed by payer: Medicaid, Medicare Part B and Medicare Advantage, commercial and self-pay.

Researchers found that over the time period studied, 56% of the total 571,545 injections were providing patients with aflibercept 2 mg; 34.8% of the injections were bevacizumab; 7.8% were for ranibizumab; 3.4% were for faricimab and less than 1% were for other, which included brolucizumab, aflibercept 8 mg, or two biosimilars of ranibizumab. The most common diseases were diabetic eye disease, retinal vein occlusion and other.

They found that patients with Medicare received aflibercept 2 mg at significantly higher rates than bevacizumab. For those with Medicaid, researchers found that patients were marginally statistically greater usage of bevacizumab over aflibercept 2 mg. For patients with commercial insurance, there was no significant difference in aflibercept 2 mg vs bevacizumab.

From 2017 to the end of 2023, the rate of aflibercept 2 mg usage increased by a factor of four, and the rate of bevacizumab doubled. Over the same period, the rate of ranibizumab fell by more than 25%.

The rate of faricimab increased by a factor of five from 2022 to 2023. Faricimab was approved in January 2022 as Vabysmo, a bispecific antibody that targets and targets two disease pathways that drive wet age-related macular degeneration (AMD) and diabetic macular edema (DME). Vabysmo is given one to four months apart in the first year following four initial monthly doses.

Researchers suggested future studies could compare the use of aflibercept 2 mg and 8 mg and also compare the two doses of aflibercept with faricimab and bevacizumab specifically among Medicare patients.