Aflibercept in wet age-related macular degeneration: a perspective review

Abstract

In the treatment of neovascular age-related macular degeneration (AMD), vascular endothelial growth factor (VEGF) has emerged as a key target of therapy. Currently, patients with neovascular AMD are treated with monthly intravitreal injections of anti-VEGF medications. Aflibercept is a novel recombinant fusion protein engineered to bind all isoforms of VEGF-A, VEGF-B, and placental growth factor. It is the latest medication to receive US Federal Drug Administration (FDA) approval for the treatment of neovascular AMD. Theoretical models suggest this molecule may have a longer duration of action compared with current treatments. The results of the VEGF Trap-Eye: Investigation of Efficacy and Safety in wet Age-related Macular Degeneration studies (VIEW 1 and VIEW 2) support this by demonstrating that aflibercept, dosed every 2 months after a monthly loading dose for 3 months, was noninferior in the proportion of patients who maintained or improved vision at 52 weeks compared with monthly injections of ranibizumab. These results were maintained over the 2 years of the studies. Aflibercept (Eylea; Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA and Bayer, Basel, Switzerland) was approved by the FDA for the treatment of neovascular AMD on 18 November 2011.

Recent developments in the treatment of age-related macular degeneration

“…50). Theoretical models suggested that this molecule may have a longer duration of action compared with current treatments (61). In recent phase 3 clinical trials, aflibercept, administered every second month after three monthly loading doses over 12 months, proved to be noninferior to monthly injections of ranibizumab, although with increased VEGF affinity, long-term follow-up for evaluation of neuronal degeneration is important (VIEW 1 and VIEW 2 studies, ref.…”

Six-month results of intravitreal aflibercept injections for patients with polypoidal choroidal vasculopathy

“…Since it has been reported to have a substantially higher binding affinity for VEGF and a potentially longer duration of action in the eye than ranibizumab, aflibercept might, a priori, be predicted to be a potentially more effective treatment for AMD 15 16. In fact, in the VIEW ii studies, intravitreal aflibercept injections were as effective as ranibizumab in improving visual acuity in patients with AMD, but required fewer injections for the same effect 17.…”

Different effects of intravitreally injected ranibizumab and aflibercept on retinal and choroidal tissues of monkey eyes

“…Aflibercept (VEGF Trap-Eye, Eylea, Regeneron/Bayer) is a new anti-VEGF agent recently approved by the Food and Drug Administration. It is a fully human, recombinant fusion protein composed of the second immunoglobulin (Ig)-binding domain of VEGFR1 and the third Ig-binding domain of VEGFR2 fused to the fragment crystallisable (Fc) region of human IgG1 15. Aflibercept binds to all VEGF-A isoforms, VEGF-B and PlGF 11…”