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

Medically reviewed by Carmen Pope, BPharm. Last updated on Sep 5, 2023.

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

Related Questions

References
  • Yorston D. (2014). Intravitreal injection technique. Community eye health, 27(87), 47.
  • Cao X, Castillo Sanchez J, Patel T, et al. Aflibercept is more effective than bevacizumab at weaning neovascular age-related macular degeneration patients off therapy
  • Eylea HD. Prescribing Information. Updated Aug 28, 2023. https://www.drugs.com/pro/eylea-hd.html#s-34092-7
  • Eylea. Updated Sep 1, 2022. Prescribing Information. https://www.drugs.com/pro/eylea.html

Read next

Eylea and Eylea HD injections into the eye (intravitreal) are associated with a substantial but temporary increase in blood pressure in some patients. Increases in intraocular pressure (the pressure inside the eye) have also been seen within 60 minutes of an injection of Eylea or Eylea HD. Continue reading

Eylea patents are due to run out from 2023 to 2039; however, these should not be taken as definite dates as there are many ways drug companies can extend their patents, for example, by changing the formulation of their product. A new Eylea HD patent, US11103552B2 which relates to high concentration VEGF receptor fusion protein containing formulations, has a patent expiry date of 15 May 2039. Continue reading

Eylea HD is a higher dose, longer-acting formulation of Eylea that has been approved to treat Neovascular (Wet) Age-Related Macular Degeneration (wAMD), Diabetic Macular Edema (DME), and Diabetic Retinopathy (DR). Eylea is approved to treat these conditions in addition to Macular Edema Following Retinal Vein Occlusion (RVO) and Retinopathy of Prematurity (ROP). Continue reading

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