I see this as a trial for "Bilea", the combination therapy for...

I see this as a trial for "Bilea", the combination therapy for use as a second-line if the response to Eylea dimishes.

Therefore, if you trial the combination treatment against Eylea alone, in a group of patients that have already had extensive anti-VEGF treatment in the past, and you're able to show that the combination treatment elicits are response in patients with recalcitrant disease (ie, where the response to monotherapy has plateaued), then there is an obvious market for this treatment.

It is an open question as to whether or not using "treatment-naive" eyes instead of "previously treated" eyes would have led to the company reporting statistically significant results in their announcement last week.

But I think it would be more difficult to market a combination drug for use in a treatment-naive cohort. Like everything in medicine, you escalate treatment in a step-wise progression, from mono-therapy to duel-therapy, etc.

There is great potential to offer a combination therapy for patients who have already previously demonstrated a positive (yet incomplete) response to Eylea monotherapy.

At the moment, for a sizable proportion of DME patients who fail to respond to Eylea, their next step in escalation is Ozurdex. But that introduces a suite of other considerations / adverse responses, such as needing to be pseudophakic, potential for OHT/glaucoma, etc etc. Good to avoid steroids if possible.