Ziv‐aflibercept: A cost‐effective, off‐label, highly potent antagonist of vascular endothelial growth factor

Abstract

Ziv-aflibercept (Zaltrap â ), a recombinant fusion protein that binds diffusible vascular endothelial growth factor (VEGF), is approved for the treatment of metastatic colorectal carcinoma. Its molecular structure is the same as aflibercept (Eylea â ), thus making it an attractive option for the off-label treatment of chorioretinal vascular conditions. Ziv-aflibercept is distributed in 4 and 8 ml vials for intravenous use, and its cost after compounding is similar to bevacizumab. Studies with retinal pigment epithelium cytotoxicity, animal histologic sections and electroretinography have demonstrated its safety, and mathematical modelling combined with over four dozen clinical publications from different ophthalmic centres throughout the world attest to its efficacy. No appreciable differences in visual or anatomic outcomes between 1.25 mg (0.05 ml) and 2.5 mg (1.0 ml) doses have been noted. The long duration of action combined with the low cost make ziv-aflibercept an attractive anti-VEGF treatment option, especially in low-and middle-income countries where its popularity is increasing.

Safety of Intravitreal Injection of Biosimilar of Aflibercept in Rabbit Eyes

“…In this regard, some similar drugs to aflibercept have been investigated. For example, an identical isomer of aflibercept called ziv-aflibercept has been shown to have comparable effect to aflibercept though it costs about half of bevacizumab (around $30 per dose) [ 18 , 19 ].…”

Intravitreal Therapy for Diabetic Macular Edema: An Update

“…Ziv-aflibercept (Zaltrap, Sanofi-Aventis US, LLC, Bridgewater, New Jersey, USA, and Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA), a recombinant fusion protein, has a mechanism that is similar in action to that of aflibercept and is available at a lower cost than the proprietary anti-vascular endothelial growth factor (VEGF) drug [ 82 , 83 ].…”

Treatment of Macular Edema in Vascular Retinal Diseases: A 2021 Update

“…Possibilities for future treatment include ziv-aflibercept, which was proposed as a new recombinant fusion protein and which has a mechanism of action similar to that of aflibercept; however, it is available at a lower cost than the proprietary anti-VEGF drug [70]. It was reported to be effective and safe in DME treatment and other retinal diseases; however, further studies are needed [70,71].…”

“…Possibilities for future treatment include ziv-aflibercept, which was proposed as a new recombinant fusion protein and which has a mechanism of action similar to that of aflibercept; however, it is available at a lower cost than the proprietary anti-VEGF drug [70]. It was reported to be effective and safe in DME treatment and other retinal diseases; however, further studies are needed [70,71]. Because of the longer intravitreal half-life of the new generation anti-VEGF-A inhibitors, including brolucizumab, abicipar pegol, and angiopoietin combination drugs, improved prolonged edema reduction and less frequent injections appear to be required [11,28].…”