Wet macular degeneration has been successfully treated with injections in the eye for the past 8 years. Although most patients are grateful that there is an effective treatment for this previously blinding condition, they have been looking forward to a more convenient treatment. A step in the right direction came late last year when Eylea was by the Food and Drug Administration (FDA) for wet age related macular degeneration.
The drugs that are presently used for this condition all block a process where growth factor is released by the diseased retina. Macugen was the first drug on the market but compared to the newer drugs, is effective in a smaller percentage of patients. The most widely used FDA-approved drug, Lucentis, is injected every 4 weeks and works very well for many patients. For some patients, the time between injections can be stretched out but this increases the chances of irrecoverable vision loss. Avastin is another drug commonly used but is not FDA approved for use in the eye. It is generally given every 4 to 6 weeks. Last year the one year results of a study between Avastin and Lucentis were released showing that the vision results at one year were similar. However, there was significantly more residual fluid in the Avastin patients suggesting incomplete resolution. The two year results will likely be out this year and may shed light on the effect of this fluid. Avastin is much cheaper than Lucentis but patients and doctors need to weigh the cost versus the aforementioned fluid. Another consideration is that Avastin is not processed in an FDA approved facility raising concerns about its sterility and consistency. Eylea’s main advantage is that it is FDA approved for use every 8 weeks. The patient receives 3 injections 4 weeks apart and then can safely go 8 weeks between shots. The trials also found that there was no more fluid than in the Lucentis patients. The cost is about half of the Lucentis because patients can go twice as long between treatments.
At our practice, we strive to stay at the forefront on technology but we temper our enthusiasm so as not to risk our patients’ safety. I have been in practice long enough to see treatments come and go without living up to their promise. I have switched my Lucentis patients to Eylea only if they weren’t responding as well as I expected. At the time of this writing, I have seen that the results are very similar with this new drug. None of the patients have finished the series of three injections so that they can go to the 8 week schedule but I am optimistic.
Eylea is only approved for wet age related macular degeneration while Lucentis is approved for multiple retinal conditions. Although 8 weeks between treatments is a step in the right direction we are all hoping for the time when there is a complete cure or at least a treatment that needs to be repeated every 6 to 12 months.