Initial Utilization of Aflibercept in Exudative Age-related Macular Degeneration

Cho, Hyung; Weber, M.; Shah, Chirag P.; Heier, Jeffrey S.

doi:10.5301/ejo.5000421

Cited by 3 publications

(2 citation statements)

References 16 publications

(17 reference statements)

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“…22 Other publications reported suboptimal response to anti-VEGF-A therapy. [23][24][25] Given the slightly different mechanism of action, with a more comprehensive down-regulation of pro-angiogenic factors, aflibercept seems a rational therapeutic alternative in this scenario. Aflibercept has shown a longer estimated intravitreal half-life of 7.1 days and a duration of clinical action possibly as long as 2.5 months, as well as a molecular configuration that allows binding to all VEGF isoforms, a binding affinity almost 100 times higher than that of ranibizumab and bevacizumab, and an ability to bind and inhibit VEGF as well as PlGF-1 and PlGF-2 and VEGF-B.…”

Section: Discussionmentioning

confidence: 99%

Intravitreal aflibercept efficacy in neovascular age-related macular degeneration with suboptimal response to anti-vascular endothelial growth factor-A therapy

Monés

Biarnés

2019

European Journal of Ophthalmology

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Importance: To provide new insights into aflibercept effect in non-naive-treated patients with neovascular age-related macular degeneration. Purpose: To assess the efficacy of intravitreal aflibercept in patients with neovascular age-related macular degeneration without optimal response to previous anti-vascular endothelial growth factor A therapy. Design: Single-arm, multi-centre, prospective study. Participants: Patients ⩾50 years with active neovascular age-related macular degeneration, best-corrected visual acuity between 20/32 and 20/320 with suboptimal response to ranibizumab or bevacizumab. Methods: Aflibercept was administered monthly (3-first months), and bimonthly thereafter until month 8. Anatomical and functional outcomes were assessed. Main outcome measure: Percentage of eyes without intra or subretinal fluid on optical coherence tomography after 3-monthly loading doses of aflibercept. Results: A total of 46 patients were included. At week 12, 45.7% (95% confidence interval: 31.5%–60.1%) of eyes showed no fluid on optical coherence tomography. The mean (standard deviation) best-corrected visual acuity increased from 65.1 (8.3) to 69.6 (8.1) letters (+4.5 (5.8) p < 0.0001) and was stabilized at week 40 as compared to baseline. Mean central macular thickness decreased from 430 (119) µm to 323 (100) µm at week 12 (–107 (90) µm, p < 0.0001) and was reduced at week 40 (–46 (111) µm, p = 0.0056). At week 40, 21.7% (95% confidence interval: 9.8%–33.7%) had no fluid. There was a case of presumed noninfectious endophthalmitis that was successfully managed. Conclusion: Almost half of patients presented no fluid on optical coherence tomography at week 12, and there was a clinically significant improvement in best-corrected visual acuity. At week 40, one in five patients did not show intra or subretinal fluid, central macular thickness decreased and best-corrected visual acuity was stabilized compared to baseline.

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Section: Discussionmentioning

confidence: 99%

Intravitreal aflibercept efficacy in neovascular age-related macular degeneration with suboptimal response to anti-vascular endothelial growth factor-A therapy

Monés

Biarnés

2019

European Journal of Ophthalmology

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“…Intravitreal injection of aflibercept also showed promising results by entrapping the VEGF and regression of choroidal vascularization. Head-to-head trials comparing the aflibercept with ranibizumab have shown similar effects on wet AMD [22,30,31,42]. Among these available therapeutic options, ranibizumab and aflibercept have more confirmed clinical documents about their effectiveness in wet AMD management and also lower risk of side effects.…”

Section: Head-to Head Trials Comparing Different Anti-vegf Agents Formentioning

confidence: 94%

Ranibizumab and aflibercept for the treatment of wet age-related macular degeneration

Yazdi

Faramarzi

Nikfar

et al. 2015

Expert Opinion on Biological Therapy

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Aflibercept: a review of its use in the treatment of choroidal neovascularization due to age-related macular degeneration

Balaratnasingam

Dhrami-Gavazi

McCann

et al. 2015

OPTH

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Choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) is an important cause of visual morbidity globally. Modern treatment strategies for neovascular AMD achieve regression of CNV by suppressing the activity of key growth factors that mediate angiogenesis. Vascular endothelial growth factor (VEGF) has been the major target of neovascular AMD therapy for almost two decades, and there have been several intravitreally-administered agents that have enabled anatomical restitution and improvement in visual function with continual dosing. Aflibercept (EYLEA®), initially named VEGF Trap-eye, is the most recent anti-VEGF agent to be granted US Food and Drug Administration approval for the treatment of neovascular AMD. Biologic advantages of aflibercept include its greater binding affinity for VEGF, a longer intravitreal half-life relative to other anti-VEGF agents, and the capacity to antagonize growth factors other than VEGF. This paper provides an up-to-date summary of the molecular mechanisms mediating CNV. The structural, pharmacodynamic, and pharmacokinetic advantages of aflibercept are also reviewed to rationalize the utility of this agent for treating CNV. Results of landmark clinical investigations, including VIEW 1 and 2 trials, and other important studies are then summarized and used to illustrate the efficacy of aflibercept for managing treatment-naïve CNV, recalcitrant CNV, and CNV due to polypoidal choroidal vasculopathy. Safety profile, patient tolerability, and quality of life measures related to aflibercept are also provided. The evidence provided in this paper suggests aflibercept to be a promising agent that can be used to reduce the treatment burden of neovascular AMD.

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Initial Utilization of Aflibercept in Exudative Age-related Macular Degeneration

Cited by 3 publications

References 16 publications

Intravitreal aflibercept efficacy in neovascular age-related macular degeneration with suboptimal response to anti-vascular endothelial growth factor-A therapy

Intravitreal aflibercept efficacy in neovascular age-related macular degeneration with suboptimal response to anti-vascular endothelial growth factor-A therapy

Ranibizumab and aflibercept for the treatment of wet age-related macular degeneration

Aflibercept: a review of its use in the treatment of choroidal neovascularization due to age-related macular degeneration

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