Regeneron Pharmaceuticals announced that the US Food and Drug Administration (US FDA) has approved Eylea (aflibercept) injection for the treatment of macular edema following retinal vein occlusion (RVO), which includes macular edema following branch retinal vein occlusion (BRVO) in addition to the previously-approved indication of macular edema following central retinal vein occlusion (CRVO).  The recommended dosage of Eylea in patients with macular edema following RVO is 2 milligrams (mg) every month (4 weeks).

"RVO is a significant cause of vision impairment in the US, and this expanded indication across all forms of RVO will provide an important new treatment option for retina specialists and their patients," said George D. Yancopoulos,  chief scientific officer of Regeneron and president of Regeneron Laboratories. "Regeneron remains committed to studying Eylea for the treatment of multiple VEGF-driven retinal diseases."  

RVO is the second most common retinal vascular disease. It occurs when there is an obstruction in a vein in the retina, the light-sensitive nerve tissue lining the back of the eye.  The blockage causes a backup of blood and leads to poor blood supply in the affected retina.  This results in the release of Vascular Endothelial Growth Factor (VEGF), a naturally occurring protein in blood vessels that causes them to become leaky.  The leaky vessels result in swelling in the center portion of the eye called the macula (a condition called macular edema), which is the most common cause of vision impairment in RVO.  In CRVO, the blockage occurs in the central retinal vein, the main blood vessel that carries de-oxygenated blood out of the back of the eye.  In BRVO, the blockage occurs in a smaller retinal vein that drains blood away from the retina.  RVO affects approximately one to two percent of adults over the age of 40.  While BRVO is four times more common than CRVO, CRVO generally is the most significant threat to vision.

The expanded indication is based on the previously-approved indication for macular edema following CRVO and the positive results from the double-masked, randomized, controlled phase 3 VIBRANT study of 181 patients with macular edema following BRVO.  The VIBRANT study compared Eylea 2 mg once every 4 weeks with macular laser photocoagulation (control).  At 24 weeks, significantly more patients treated with Eylea gained at least 15 letters in vision (three lines on an eye chart) from baseline as measured on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart, the primary endpoint of the study, compared with patients who received control (53 per cent vs. 27 per cent; P less than 0.01).  Patients treated with Eylea achieved a 17.0 letter mean improvement over baseline in best-corrected visual acuity (BCVA) compared to a 6.9 letter mean improvement in patients who received control (P less than 0.01), a key secondary endpoint.

The incidence of non-ocular serious adverse events (SAE) was 8.8 per cent in the Eylea group and 9.8 per cent in the control group.  One death and one Anti-Platelet Trialists' Collaboration (APTC)-defined arterial thromboembolic event (non-fatal stroke) occurred during the trial, both in patients in the control group.  The most common ocular adverse events in patients treated with Eylea included conjunctival hemorrhage and cataract.  There were no cases of intraocular inflammation in either group.  There was one ocular SAE in a patient in the Eylea group, which was traumatic cataract.

VIBRANT is the first phase 3 trial in macular edema following BRVO in which an anti-VEGF agent was directly compared to laser photocoagulation at baseline (control).  The study continued through 52 weeks, and the one-year results were presented at the American Society of Retina Specialists annual meeting in August 2014.

Eylea is available as a single, 2-mg strength intravitreal injection for all approved indications.  Eylea is approved in the US for the treatment of wet AMD, macular edema following RVO, and DME.  In the EU and other countries, Eylea is approved for the treatment of wet AMD, macular edema following CRVO, and DME. Regulatory submissions have been made for Eylea in the EU and other countries for macular edema following BRVO.

Eylea is a vascular endothelial growth factor (VEGF) inhibitor formulated as an injection for the eye.  Eylea 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.  Eylea helps prevent VEGF-A and PLGF from interacting with their natural VEGF receptors as shown in preclinical studies.