Intravitreal aflibercept: its role in treatment of neovascular age-related macular degeneration

ABSTRACT

Introduction: Age related macular degeneration (AMD) affects over 14 million people worldwide and is the commonest cause of visual loss in the over 65’s age group in the industrialised world. The neovascular form of AMD (nAMD) is responsible for the majority of severe visual loss. The introduction of anti-vascular endothelial growth factor (anti-VEGF) agents in the mid 2000’s revolutionised the treatment of nAMD. Of the current three anti-VEGF agents widely used, Aflibercept (EYLEA®; Regeneron Pharmaceutical Inc., Tarrytown, NY, USA/Bayer Healthcare, Berlin, Germany) was the latest to be introduced.

Areas covered: The different forms of AMD and previous treatments for nAMD are described. Current treatment regimens using anti-VEGFs are reviewed with particular emphasis on aflibercept, its specific properties and dosing strategies.

Expert commentary: Clinical trials demonstrated that aflibercept achieved the same results using an 8 weekly dosing regimen, compared to a 4 weekly ranibizumab regimen. This reduction in injection frequency reduces hospital visits, thus benefiting patients and hospital eye services. Different treatment regimens including ‘as required’, and ‘treat and extend’ protocols have enabled further reductions in injection frequency, but with careful monitoring to avoid visual loss. Further developments are required to identify those who need fewer injections. The introduction of longer lasting, or topical agents, or strategies for primary prevention represent potential future developments.

KEYWORDS:

• Age-related macular degeneration (AMD); aflibercept (Eylea)
• anti-vascular endothelial growth factor agents (anti-VEGFs); Bevacizumab (Avastin)
• CLEAR-IT trials
• ranibizumab (Lucentis)
• neovascular age related macular degeneration (nAMD)
• vascular endothelial growth factor (VEGF)
• VEGF-TRAP
• VIEW trials

Declaration of interest

Mital Shah has been awarded the Global Ophthalmology Awards Programme Fellowship Project Award from Bayer and has been PI on grants from the National Eye Research Centre, Dowager Countess Eleanor Peel Trust and Oxford Hospitals Charity.

Susan Downes has received honoraria in the past 15 years from Novartis, and Bayer for speaking at Educational meetings, as well as travel expenses from Ely Lilly as chair for diabetic retinopathy screening meetings, and Novartis to attend educational meetings in Medical Retina pre 2010. In the last 5 years she has been a PI on a number of commercially sponsored trials by Bayer, Allergan, Alcon, Novartis and Roche, and has received a bursary for a research nurse practitioner and equipment (visudyne pump for photodynamic therapy) and funding to carry out genetic testing for a research project from Novartis. She also has has been a co-PI or PI on grants from Wellcome, UK Fighting Blindness RP, Fight for Sight and UK National Institute for Health Research/Clinical Research Network funding.

The authors have 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. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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Funding

This study was not funded.