Vascular endothelial growth factor (VEGF) antagonists for central retinal vein occlusion: an update on clinical progress

ABSTRACT

Background

Retinal vein occlusions are the second most common retinal vascular conditions, with central retinal vein occlusions (CRVOs) generally responsible for the most significant vision loss.

Research Design and Methods

A PubMed search for ‘central retinal vein occlusions’ was performed from 2013 to 2023. Online searches were performed for biosimilars and recently approved drugs. Relevant studies were reviewed and referred to in the manuscript.

Results

Drugs that inhibit the actions of vascular endothelial growth factor have become standard-of-care for CRVO-associated macular edema. Bevacizumab, ranibizumab, and aflibercept each decreases central subfield thickness and improves visual acuity (VA) by an average of + 15 to + 17 letters, but retrospective and database studies show that patients outside of registration trials generally receive fewer injections and achieve poorer improvements in VA. Some comparison studies show no differences in peak efficacies whereas others suggest that aflibercept produces the best gains in BCVA. Similarly, studies that report switching of drugs due to poor initial responses, report mixed data or show aflibercept superiority.

Conclusions

During the past 10 years, only two ranibizumab biosimilars have been approved for CRVO, but over the next five years, approvals of faricimab, aflibercept 8 mg, and additional ranibizumab and aflibercept biosimilars are likely.

KEYWORDS:

• Aflibercept
• anti-VEGF
• bevacizumab
• central retinal vein occlusion
• macular edema
• ranibizumab

Article highlights

• Most controlled studies show that the initial choice of drug makes little difference regarding visual acuity gains.

• In eyes that achieve less-than-expected results with bevacizumab, switching to aflibercept may improve visual acuity and central subfield thickness.

• The improvement of ranibizumab biosimilars has decreased the use of Lucentis, and similar shifts in utilization are likely to occur when aflibercept biosimilars are approved in 2025.

• Five years from now, faricimab and aflibercept 8 mg will likely be the most commonly branded drugs.

Declaration of interest

The author reports institutional research support from Alexion and Abbvie, and consulting fees from Alkahest, Bayer, Biogen, and Re-vana. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

A reviewer on this manuscript has disclosed they received consultation honoraria and speaker fees from Abbvie, Bayer, Novartis, Regeneron, Roche. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Author contributions

The sole author, Michael W. Stewart, contributed exclusively to the conception and design of the review article and interpreting the relevant literature, and has written the entire article.

Additional information

Funding

Thispaper was not funded.