Understanding Retinal Disease and Anti-VEGF Therapy
Retinal diseases such as neovascular (wet) age-related macular degeneration (nAMD), diabetic macular edema (DME), and macular edema following retinal vein occlusion (RVO) can lead to vision loss by causing abnormal blood vessel growth and leakage in the macula. The macula is the part of the retina responsible for sharp central vision. Anti-VEGF (anti-vascular endothelial growth factor) therapy, delivered via intravitreal injection, is the standard of care for these conditions, aiming to halt vision loss and, in some cases, improve sight.
This article provides a comprehensive comparison of two leading anti-VEGF treatments, Eylea and Vabysmo, helping to clarify the key differences and considerations for patients and healthcare providers when determining which is better, Eylea or Vabysmo.
Mechanisms of Action: The Core Difference
The most significant distinction between Eylea and Vabysmo lies in their mechanism of action. While both combat the effects of vascular endothelial growth factor (VEGF), a protein that promotes the growth of abnormal and leaky blood vessels, Vabysmo also targets a second pathway.
Eylea (aflibercept)
Eylea works as a decoy receptor for VEGF-A and placental growth factor (PlGF). By binding to these proteins, it prevents them from interacting with their native receptors on endothelial cells, thereby inhibiting the growth of abnormal blood vessels and reducing vascular permeability. A higher-dose version, Eylea HD (8mg), was introduced in 2023 to extend the time between injections.
Vabysmo (faricimab)
Vabysmo employs a dual-pathway approach by inhibiting both VEGF-A and angiopoietin-2 (Ang-2). While the role of VEGF inhibition is well-understood, blocking Ang-2 is believed to promote vascular stability, making blood vessels less responsive to the pro-angiogenic effects of VEGF. This dual action contributes to the medication's extended durability in some patients.
Efficacy in Clinical Trials
Clinical trials have established both Eylea and Vabysmo as highly effective treatments for retinal diseases, demonstrating significant visual and anatomical improvements. Head-to-head trials are lacking, but comparative analyses and trial data provide valuable insights.
Visual Acuity
In studies like TENAYA and LUCERNE for nAMD, Vabysmo demonstrated visual acuity improvements non-inferior to Eylea. Similarly, studies for DME (YOSEMITE and RHINE) and RVO (BALATON and COMINO) showed comparable visual acuity gains between the two treatments.
Retinal Drying
Some analyses suggest Vabysmo may have an edge in reducing retinal fluid, often measured by central subfield thickness (CST). A matching-adjusted meta-analysis presented in late 2024 showed Vabysmo providing a higher CST reduction than Eylea and Eylea HD in both DME and nAMD patients. Additionally, trials for RVO showed a higher percentage of Vabysmo patients with no blood vessel leakage compared to Eylea patients.
Dosing Frequency and Patient Convenience
One of the most compelling reasons for comparing Eylea and Vabysmo is the potential for different injection frequencies, which directly impacts patient burden and quality of life.
Vabysmo Dosing
- Initiation: Typically, monthly injections for an initial loading phase.
- Maintenance: Intervals can be extended up to every 16 weeks in eligible patients with nAMD and DME. In the TENAYA and LUCERNE trials, a significant portion of nAMD patients achieved a 4-month dosing interval, and even more reached 3 months.
Eylea Dosing
- Standard Eylea (2mg): After a loading phase, maintenance injections are typically given every 8 weeks. Many ophthalmologists also use a treat-and-extend protocol to push intervals, though this is considered off-label for the 2mg dose.
- Eylea HD (8mg): Offers extended dosing intervals, potentially up to every 3 or 4 months, providing a competitor to Vabysmo's extended durability.
Safety Profiles and Potential Side Effects
Overall, both Eylea and Vabysmo have similar safety profiles in clinical studies. The most common side effects reported for both drugs include:
- Conjunctival hemorrhage (blood in the white of the eye)
- Eye pain or discomfort
- Vitreous floaters
- Increased intraocular pressure
- Cataracts
However, some differences have been observed:
- Intraocular Inflammation: Some studies, such as the BALATON and COMINO trials for RVO, noted a low rate of intraocular inflammation with Vabysmo. This condition is usually treatable but can be serious.
- Thromboembolic Events: Both medications carry a low risk of serious blood clot-related issues, such as heart attacks or strokes, a risk factor shared by the entire class of anti-VEGF inhibitors.
Comparative Summary: Eylea vs. Vabysmo
| Feature | Eylea (Aflibercept) | Vabysmo (Faricimab) |
|---|---|---|
| Mechanism of Action | Single pathway inhibitor (VEGF-A and PlGF) | Dual pathway inhibitor (VEGF-A and Ang-2) |
| Dosing Frequency | Standard 8 weeks (2mg); Extended up to 16 weeks (8mg Eylea HD) | Extended up to 16 weeks in responsive patients |
| Efficacy (Visual Acuity) | Well-established, clinically proven non-inferior to Lucentis | Non-inferior to Eylea in clinical trials |
| Efficacy (Retinal Drying) | Proven efficacy | Some analyses suggest superior retinal drying compared to Eylea |
| Safety Profile | Similar to other anti-VEGFs; low risk of complications | Similar to Eylea; very low rate of intraocular inflammation reported |
| FDA Approval | Approved 2011 (2mg); 2023 (8mg Eylea HD) | Approved 2022 |
Conclusion: Making the Right Choice
The question of which is better, Eylea or Vabysmo, does not have a single answer and is best determined by a retinal specialist based on individual patient factors. For many patients, both are highly effective with comparable visual outcomes. Vabysmo's key advantage is its dual mechanism and demonstrated ability to extend dosing intervals to up to 16 weeks for more patients than standard Eylea, reducing the number of clinic visits. However, the availability of Eylea HD, offering similar extended dosing, means Eylea remains a strong competitor. Some evidence also suggests Vabysmo may provide superior anatomical outcomes in terms of retinal drying, which could be a factor for certain patients.
The choice is influenced by the specific retinal condition, prior treatment history, patient response, and logistical preferences regarding injection frequency. Patient-reported outcomes related to comfort and injection frequency are also important considerations. Both medications represent significant advancements in the treatment of retinal disease, offering valuable options to preserve and improve vision.
Disclaimer: This information is for educational purposes only and is not medical advice. Consult with a qualified ophthalmologist for diagnosis and treatment.
An excellent resource for more in-depth information and recent clinical trial updates is the American Academy of Ophthalmology's EyeNet Magazine, which often covers new developments in retinal treatments.(https://www.aao.org/eyenet).
Which is better, Eylea or Vabysmo?: What’s the bottom line?
Both Eylea and Vabysmo are highly effective anti-VEGF agents for treating common retinal diseases, but differ in their mechanism of action and optimal dosing schedules. Choosing between them depends on a nuanced discussion with a retina specialist, considering factors like injection frequency, anatomical response, and specific disease characteristics. Vabysmo offers dual-pathway inhibition and has shown a strong ability to extend dosing intervals for many patients, which can reduce treatment burden. However, Eylea HD also offers extended dosing, and Eylea has a longer history of use and extensive safety data, making both valid and powerful treatment options.
