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Guidance pending in 2016 for treatment of central retinal vein occlusion
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WAIKOLOA, Hawaii — Likening the SCORE2 trial to the CATT trial and the LEAVO trial to the IVAN trial, Michael S. Ip, MD, anticipates the retina community will have some guidance regarding which treatments to use for central retinal vein occlusion when the SCORE2 and LEAVO trials yield results.
“I think the comparative effectiveness research trials SCORE and LEAVO will help guide us in the future with best first-line and second-line therapies [for CRVO],” Ip said at Retina 2016.
Michael S. Ip
The SCORE2 design is a noninferiority study that will compare Eylea (aflibercept, Regeneron) and Avastin (bevacizumab, Genentech) in patients with macular edema associated with CRVO. Primary outcome at 6 months will be mean change from baseline in visual acuity letter score.
The primary endpoint of the U.K.-based LEAVO study, which also is designed to compare the two drugs, is to determine the difference between treatment arms in mean change in best corrected visual acuity at 100 weeks compared to baseline.
The multi-site SCORE2 trial completed recruitment in November 2015 and 362 eyes were randomized 1:1 to either receive bevacizumab or aflibercept. Results are planned to be released in the third quarter of this year, Ip said.
Current anti-VEGF treatments for CRVO include two FDA-approved anti-VEGF therapies – Lucentis (ranibizumab, Genentech) and aflibercept, and one off-label anti-VEGF therapy – bevacizumab, he said.
“It’s great that we have so many treatments available,” Ip said. “And I think we’ve kind of voted with our feet for Avastin. I’ve been looking at PAT surveys for many years, and it’s amazing. Avastin seems to be unshakable, with 60% to 70% of the market share. ”
However, evidence-based guidelines are needed with regard to both first-line and second-line therapies for CRVO, Ip said.
It is generally agreed upon that anti-VEGF therapy is the most appropriate first-line therapy due to the perception that anti-VEGF agents are more effective and have fewer side effects, such as cataract development and IOP elevation, than corticosteroids, Ip said.
“If this is the case, then which anti-VEGF therapy has the best efficacy and safety profile as an initial therapy?” he asked. “And a very important question is, because of the cost of bevacizumab, whether or not bevacizumab is clinically equivalent to the anti-VEGF, which we think has the broadest mechanism of action, that is aflibercept.” – by Patricia Nale, ELS
Reference:
Ip MS. Update in the management of central retinal vein occlusion. Presented at: Retina 2016; Jan. 18-22, 2016; Waikoloa, Hawaii.
Disclosure: Ip reports he is a consultant for Alimera, Boehringer Ingelheim and Thrombogenics.