Roche's Susvimo has its advantages, but eye doctors are sticking with Eylea

Roche’s new eye drug delivery therapy Susvimo is becoming well known among eye doctors, but it has a major battle on its hands to shift market share away from the major blockbuster that is Regeneron and Bayer’s Eylea.

This is according to a new report from Spherix analysts, based on conversations with 76 ophthalmologists in mid-April about their knowledge and use of Susvimo, an implantable device that dispenses a formulation of Roche's own Lucentis (ranibizumab).

The FDA approved Susvimo late last year, and Roche is angling the drug-device combo as a very different option for patients with wet age-related macular degeneration (wet AMD).

Rather than receive injections of Eylea six to 12 times a year—or even injections of Roche’s other new eye drug, Vabysmo, which is given three to 12 times a year—patients can undergo surgery to get the Susvimo implant installed and then refilled with ranibizumab twice a year.

The report found that while “the large majority” of ophthalmologists acknowledge Susvimo’s “superior duration of response” when compared to Eylea, respondents “overwhelmingly rate Eylea as safer overall and more accessible.”

That isn’t surprising: Any new drug, especially a unique system like Susvimo, will take time to win doctors over. It’s also up against a hugely successful drug in Eylea, which made $8.3 billion in sales last year.

But given that the device needs surgery and refills, concerns about safety could be high. In its pivotal phase 3 trial, the most common adverse events were bleeding in the eye's outer membrane, red and dilated blood vessels in the eye, swelling of the iris, and eye pain, Roche said. Cases of endophthalmitis, an eye infection, were also seen.

Overall, Spherix’s report showed at best a mixed bag for the therapy in its early launch phase. On the plus side, awareness is high: Only 7% of those asked said they weren’t familiar with Susvimo. And when compared to all available AMD drugs on the market, one-third said they saw Susvimo to be “a substantial advance."

But despite high physician familiarity, less than one-fifth of AMD patients are “appropriate candidates” for Susvimo, doctors told Spherix, which obviously narrows its target market considerably.  

And the report also found that patients are not asking about Susvimo. An average of just 1.7 patients requested the agent from a given doctor over the past three months.

And when they were asked, “ophthalmologists most frequently convince[d] the patients to try another agent.”

Susvimo made CHF 1 million ($1.01 million) in the first quarter, just as the launch was beginning, but Jefferies analysts expect roughly $1.4 billion in peak sales of Susvimo by 2030.

Alongside its new eye drugs in Susvimo and Vabysmo, Roche also develops and markets Lucentis in its original injectable form, which has been a perennial blockbuster for the company.

Lucentis made $1.46 billion in 2021 and is FDA-approved for a whole host of conditions, including wet AMD and diabetic macular edema, macular edema following retinal vein occlusion, diabetic retinopathy and myopic choroidal neovascularisation.

There is, however, for all of these therapies a biosimilar threat coming into the market later this year in the form of Samsung Bioepis’ Byooviz, the first FDA-approved biosimilar for use in the eye.

Launch is expected next month, but Spherix has noted in an earlier report that interest in the drug “is lukewarm”, with only 14% of surveyed ophthalmologists reporting high familiarity with the agent, and just one-quarter indicating intent to prescribe within the first three months of launch.