In September 2014, the FDA ( Food and Drug Administration ) granted Eylea ( Aflibercept ) injection Breakthrough Therapy designation for the treatment of diabetic retinopathy in patients with diabetic macular edema ( DME ).
The FDA created the Breakthrough Therapy designation to expedite the development and review of drugs for serious or life-threatening conditions. A Breakthrough Therapy drug must show preliminary clinical evidence of a substantial improvement on a clinically significant endpoint over available therapies, or over placebo if there is no available therapy.
The phase 3 VIVID-DME and VISTA-DME trials, which supported the approval of Eylea in diabetic macular edema, included a pre-specified secondary endpoint evaluating diabetic retinopathy based on an established grading scale in patients with DME.
The VISTA-DME and VIVID-DME studies of 862 patients compared Aflibercept 2 mg given monthly, Aflibercept 2 mg given every two months ( after five initial monthly injections ), or macular laser photocoagulation ( at baseline and then as needed ).
In the DME studies, at one year, the mean changes in Best Corrected Visual Acuity ( BCVA ), as measured by the Early Treatment Diabetic Retinopathy Study ( ETDRS ) chart for the monthly and every two month Aflibercept groups, were statistically significantly improved compared to the control group and were similar to each other.
Across both trials at one year, patients in both Aflibercept dosing groups gained, on average, the ability to read approximately two additional lines on an eye chart compared with almost no change in the control group.
A secondary endpoint of the trials was the proportion of patients who achieved a 2-step or greater improvement on the ETDRS diabetic retinopathy ( DR ) severity scale at two years.
In these trials, Aflibercept had a similar overall incidence of adverse events, ocular serious adverse reactions, and non-ocular serious adverse effects across treatment groups and the control group.
Arterial thromboembolic events as defined by the Anti-Platelet Trialists' Collaboration ( non-fatal stroke, non-fatal myocardial infarction, and vascular death ) also occurred at similar rates across treatment groups and the control group.
The most frequent ocular treatment emergent adverse effects ( TEAEs ) observed in the VISTA-DME and VIVID-DME trials included conjunctival hemorrhage, eye pain, cataract, and vitreous floaters.
The most common non-ocular TEAEs included hypertension and nasopharyngitis, which occurred with similar frequency in the treatment groups and the control group.
Aflibercept is a vascular endothelial growth factor ( VEGF ) inhibitor formulated as an injection for the eye. Aflibercept 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. Aflibercept helps prevent VEGF-A and PLGF from interacting with their natural VEGF receptors. ( Xagena )
Source: Regeneron Pharmaceuticals, 2014