What’s the difference between Eylea, Eylea HD, and Avastin?

Official answer

by Drugs.com

Eylea, Eylea HD, and Avastin may all be used to treat neovascular (wet) age-related macular degeneration (AMD), as injections into the eye (intravitreal injections). Both Eylea and Eylea HD are FDA-approved for this indication, but use of Avastin is off-label (not an FDA-approved indication - although it has been used for this purpose since 2005). Eylea HD is a longer acting version of Eylea (see What is the difference between Eylea and Eylea HD?).

They are all VEGF inhibitors and work by blocking VEGF, a signal protein that stimulates the growth of new blood vessels. Abnormal blood vessel growth from existing blood vessels (called angiogenesis) is associated with the progression of degenerative eye conditions such as neovascular AMD.

The main differences between Eylea, Eylea HD, and Avastin are:

Eylea is FDA-approved to treat neovascular AMD but the use of Avastin for this purpose is off-label (not FDA approved), although Avastin intravitreal injections have been used for neovascular AMD since 2005. Eylea and Eylea HD are also for other eye conditions such as Diabetic Macular Edema (DME) and Diabetic Retinopathy (DR). Eylea is also approved for Macular Edema Following Retinal Vein Occlusion (RVO) and Retinopathy of Prematurity (ROP).

Eylea is significantly more expensive than Avastin. One injection of Eylea costs around $2000 compared to $100 for an injection of Avastin. One injection of Eylea HD costs around $2600.

One retrospective analysis (Cao et al, 2022) reported that people administered Eylea were almost 3 times more likely to be weaned off treatment (also known as a treatment holiday) due to eye stabilization than those treated with Avastin (43% vs. 15% respectively). However, the study was not randomized nor blinded and could be subject to inherent bias that could have influenced the outcomes (for example, retina specialists holding the belief that Eylea is more potent).

Key Facts: Eylea Vs Avastin

	Eylea	Eylea HD	Avastin
Generic name	aflibercept	aflibercept	bevacizumab
Company	Regeneron	Regeneron	Genentech
FDA approval date	2011	2023	Not FDA-approved for neovascular AMD but has been used since 2005 FDA approved for several cancers since 2004
Generic availability	No generic	No generic	No generic
Drug class	VEGF inhibitor (anti-angiogenic ophthalmic agent)	VEGF inhibitor (anti-angiogenic ophthalmic agent)	VEGF/VEGFR inhibitor
Dosage form	Intravitreal injection	Intravitreal injection	Injection: 100 mg/4 mL (must be drawn up for intravitreal injection. Usual dose is 0.1ml [2.5mg])
Use	Neovascular AMD DME Macular edema following retinal vein occlusion Diabetic retinopathy (DR) Preterm infants with retinopathy of prematurity	Neovascular AMD (wAMD) DME Diabetic retinopathy (DR)	Use for Neovascular AMD is off label Also used off-label for macular edema, diabetic retinopathy, and retinal vein occlusion Several cancers (eg, colorectal cancer, NSCLC, ovarian cancer; see here for full prescribing information)
Dosing schedule and administration	Initially every 4 weeks then 4-12 weekly thereafter (depending on the condition) Treatment holidays may be possible for eyes that have stabilized Preterm infants: 0.4mg bilaterally on the same day; may be repeated after 10 days	Initially every 4 weeks for the first 3 doses, then once every 8 to 12 weeks for DR or 8 to 16 weeks for wAMD and DME	Every 4 to 6 weeks Treatment holidays may be possible for eyes that have stabilized
Common side effects (>5% of patients)	Conjunctival hemorrhage Eye pain Cataract Increased intraocular pressure Vitreous detachment Vitreous floaters Red eye	Conjunctival hemorrhage Eye pain Cataract Increased intraocular pressure Vitreous detachment Vitreous floaters Red eye	Red eye Dry or itchy eyes Feeling like something is in the eye Eye discomfort Temporary blurred vision Floaters
Warnings and precautions	Endophthalmitis Retinal detachments Increases in intraocular pressure within 60 minutes of administration Arterial thromboembolic events	Endophthalmitis Retinal detachments Increases in intraocular pressure within 60 minutes of administration Arterial thromboembolic events	Endophthalmitis Retinal detachments Eye infection Eye pain
Cost	$2000 per treatment	$2600 per treatment	$100 per treatment

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What’s the difference between Eylea, Eylea HD, and Avastin?

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Key Facts: Eylea Vs Avastin

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