NMA reveals superior CST improvement of Vabysmo over Eylea HD

A match-adjusted meta-analysis indirectly comparing the efficacy of Eylea HD ( aflibercept 8mg) and Vabysmo (faricimab). presented by Dr. Jennifer I Lim, MD, FARVO, FASRS, the Marion Schenk Chair in Ophthalmology for Aging Eye Research and Distinguished Professor of Ophthalmology at the University of Illinois at Chicago.

Aflibercept is a vascular endothelial growth factor (VEGF) inhibitor, available in a 2 mg dose as Eylea and in an 8 mg dose as Eylea HD. Vabysmo (faricimab) is a dual inhibitor of VEGF and angiopoietin-2 (Ang-2). Both therapies are indicated for diabetic macular edema (DME) and neovascular age-related macular degeneration (nAMD), among other diseases. Although numerous studies have investigated both therapies individually, to date there have been no trials directly comparing the two therapies.

This study aimed to compare 12-week data from relevant phase III trials for Eylea HD and Vabysmo, with the aim of unraveling which treatment provided superior reductions in central subfield thickness (CST). This was achieved by comparing data from the DME YOSEMITE/RHINE trials with PHOTON and the nAMD TENAYA/LUCERNE trials with PULSAR. All trials within the respective sub-indications had a common comparator, Eylea, which served as the anchor in this study, to facilitate the comparison between Eylea HD and Vabysmo. The trial duration was set at 12 weeks to ensure that patients in all trials used in the network meta-analysis (NMA) received the same number of injections, either Eylea, Eylea HD or Vabysmo.

After selecting the relevant clinical trials to conduct the NMA, the YOSEMITE/RHINE trial populations, comparing Eylea with Vabysmo in patients with DME, were compared with the baseline characteristics of the PHOTON trial, comparing Eylea with Eylea HD in patients with DME. The comparison was carried out based on characteristics such as mean age, average best-corrected visual acuity (BCVA), diabetic retinopathy severity scale (DRSS) absent, mild or moderate and, in particular, average CST, previous treatment with anti-VEGF and moderately severe or severe. Severe DRSS, characteristics that had a greater difference at baseline between the PHOTON and YOSEMITE/RHINE trials. This was done by applying weights and the YOSEMITE/RHINE results were modified accordingly.

Results revealed that in patients with DME, Vabysmo provided greater CST reduction compared to Eylea HD, with Vabysmo CST thinning 19 µm more than Eylea and Eylea HD from baseline to at week 12, showing that Vabysmo dries better than Eylea and Eylea HD.

This analysis was then performed on the respective nAMD data. Data from TENAYA/LUCERNE, which compared Eylea with Vabysmo in patients with nAMD, were compared with the baseline characteristics of the PULSAR trial, which compared Eylea with Eylea HD in patients with nAMD. In this case, the comparison was carried out on characteristics that included mean age, mean BCVA, mean CST, and mainly the percentage of absence of intraretinal fluid or subretinal fluid and characteristics of the lesion area mean that they had a larger difference at baseline between PULSAR and TENAYA/LUCERNE. essays In this analysis, the results obtained from the DME trial were further established, again demonstrating a higher CST reduction with Vabysmo than Eylea HD, with Vabysmo CST thinning of 19 µm more than Eylea and 17 µm more than Eylea HD from baseline to week 12, confirming that Vabysmo dries better than Eylea and Eylea HD.