J.P. Morgan: Eylea HD use expands: Can Merck’s ophthalmology pipeline catch up?

Where is Eylea HD’s growth coming from?

Retina specialist Carl Regillo said that the every-four-weeks dosing regimen and the expansion into retinal vein occlusion (RVO) have led him to increase his use of Eylea HD. It is currently the fastest-growing retinal therapy in his practice by use.
JPMorgan expects label expansion to continue driving steady growth for Eylea HD, but declines in the original Eylea 2mg will offset some of that growth. The bank also expects Dupixent to gradually contribute the majority of Regeneron’s profits as it scales up.
The expert considers the prefilled syringe convenient to use, but its launch will not cause a sudden change in Eylea HD use: he had not previously chosen other drugs solely because this syringe was unavailable.

The expert considered the data from DAYBREAK, Kodiak’s trial of Zenkuda in wet age-related macular degeneration, excellent, particularly its durability of efficacy and reduction of retinal fluid. However, he said commercial payers currently generally require patients to try other treatments first, and only about 10%–20% of patients can receive his preferred drug as initial treatment.
Eylea HD and Vabysmo are typically placed in the third line of treatment. If Zenkuda is also placed in the third line, the expert believes patients who need more frequent injections may switch to it, but those doing well on their current treatment may not; if it is placed in the fourth line or later, widespread use will be delayed.
JPMorgan therefore expects Zenkuda may initially attract a group of patients who respond poorly to existing third-line treatments, but payer restrictions and patient affordability will slow further adoption, with a relatively modest impact on the Eylea franchise.

The expert believes remigromig may suit patients who respond poorly to existing therapies; he is interested in its non-inferiority performance versus Lucentis in the preliminary BRUNELLO results. JPMorgan will focus on the full data at the AAO meeting later in the week of the report’s publication.
The earlier-stage MK-8748 has a mechanism that acts on both Tie2 and VEGF. The expert considers its early data encouraging, but says it must demonstrate a clinically meaningful advantage in a head-to-head trial against Eylea to gain market share.