Earlier this month at the J.P. Morgan Healthcare Conference, Regeneron got its Eylea sales news out of the way. As has been the case for several quarters, as sales of Eylea HD have increased, those of Eylea’s original formula have declined by a larger margin.
The result over time has been a significant decline in U.S. sales of the overall Eylea franchise, from $1.50 billion in the fourth quarter of 2024 to $1.08 billion in the fourth quarter of last year.
Friday, when Regeneron presented its Q4 and 2025 financial results in full, the company said that it expects the trend to continue in the first quarter of this year, with high single-digit growth for Eylea HD being more than offset by a double-digit decline for Eylea’s original version.
Two seasonal timing factors are at play that will affect the performance of the eye disease drug in the first quarter, Regeneron’s commercial chief Marion McCourt said during a conference call.
“The first quarter is typically impacted by patient reauthorizations and—as we disclosed earlier this month—wholesaler inventory levels were elevated by approximately $30 million at the end of the fourth quarter for Eylea HD as well as Eylea,” McCourt said. “We expect first-quarter net sales will be negatively impacted as the inventory is absorbed.”
For 2025 overall, combined U.S. sales of the Eylea treatments reached $4.4 billion, which was a 27% decline from 2024. The figure is also down from Eylea’s peak figure of $6.3 billion in 2022.
Much of the four-year slide can be attributed, of course, to Roche’s competing treatment Vabysmo, which was approved in 2022 and raked in worldwide sales of 4.1 billion Swiss francs ($5.3 billion) last year. But there are other headwinds at play as well that are affecting the entire category of anti-vascular endothelial growth factor (VEGF) drugs.
In its presentation on Thursday, Roche identified a “contraction of the U.S. branded market” for anti-VEGF drugs, as doctors are prescribing less expensive alternatives such as Avastin and Eylea biosimilars.
These factors even knocked Vabysmo off its juggernaut trajectory, as its sales in the second half of 2025 were less than those in the first half by 32 million Swiss francs ($42 million). It was the first time since its launch that Vabysmo had a sequential decline.
Regeneron acknowledged the category’s recent market decline, citing a 7% sequential sales slide from the third to the fourth quarter of 2025 for the class. Despite that, there still are positive signs for Eylea HD, which benefited from a 10% increase in sequential physician demand, according to Regeneron.
This trend highlighted “Eylea HD’s strong clinical profile and commercial momentum,” McCourt said.
There are other reasons to believe that Eylea HD can spearhead a turnaround, Regeneron said. In November, the company got two long-awaited FDA expansions for a monthly dosing option and retinal vein occlusion.
“Eylea HD now has the broadest label and greatest dosing flexibility of any anti-VEGF medicine,” McCourt said. “Physicians were eagerly awaiting both label enhancements and we are seeing positive early launch signals in our efforts to get this medicine to even more patients.”
Another boost is expected with an anticipated approval for Eylea HD to be available to physicians in a pre-filled syringe. The company is projecting that an FDA nod will come in the second quarter.
Additionally, Regeneron said on Friday that the FDA has approved a new manufacturer, which will be able to perform fill-finish for vials of Eylea HD. FDA approvals for the previous label expansions for Eylea HD were held up by problems at the company’s primary third-party manufacturer, Novo Nordisk (Catalent).
As for Regeneron’s overall performance, the company reported total sales of $3.9 billion for the quarter, which were up by 3% year over year and topped the analyst consensus. For the year, Regeneron's revenues were up 1% to $14.3 billion.
Doing the heavy lifting, as usual, was Sanofi-partnered Dupixent, which achieved sales of $4.9 billion in the quarter, which were up 34%, with Regeneron’s collaboration revenue coming to $1.6 billion.
Cancer drug Libtayo also continued to surge, with revenues reaching $425 million for the quarter and $1.45 billion for the year, which was a 19% gain from 2024.