Aflibercept for diabetic macular edema

Abstract

Different intravitreal anti-VEGF medications have been used for the management of retinal vascular disorders with highly satisfactory results and good safety profiles. Aflibercept, a new anti-VEGF drug with a different mechanism of action compared with prior therapies, has recently emerged. The results of aflibercept Phase II and III studies show its efficacy for the treatment of wet age-related macular degeneration, macular edema secondary to central retinal vein occlusion and diabetic macular edema.

Keywords::

• aflibercept
• anti-VEGF
• avastin
• intravitreal injection
• laser
• macula
• macular degeneration
• macular edema
• ranibizumab
• retina

Acknowledgements

A Cisneros contributed to making the use of the drug possible in the hospital and reviewed the manuscript; J Navarro helped in the management of patients treated with the drug and provided assistance in writing the manuscript. S Garcia assisted with the manuscript references.

Financial & competing interests disclosure

P Udaondo discloses relationships with Alcon, Allergan, Bausch & Lomb, Bayer, Gene Signal and Thea Pharma. S Garcia discloses relationships with Aaren, Allergan, Bausch & Lomb, Gene Signal, Mediphacos and Thea Pharma. 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.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Sustained hyperglycemia causes a multifactorial cascade of physiological responses, involving increased permeability, altered blood flow, hypoxia and inflammation. Secondary to this, several growth factors and proinflammatory mediators are upregulated; VEGF-A is a major contributor to each one of these processes.

• Aflibercept, a new anti-VEGF drug, has shown in Phases II and III studies its efficacy for the treatment of wet age-related macular degeneration, macular edema secondary to central retinal vein occlusion and diabetic macular edema.

• Aflibercept has shown a higher affinity to VEGF and a longer duration of action compared with other agents, which could reduce the number of injections per patient and allow less frequent monitoring while maintaining clinical efficacy.

• Phase I studies showed that ocular adverse events were, in general, mild; it was described that a higher incidence of transient intraocular pressure, eye pain, conjunctival hemorrhage and vitreous floaters and vitreous hemorrhages were seen in the aflibercept groups considering all the indications (diabetic macular edema, vein occlusion and wet age-related macular edema).

• Serious ocular adverse events were infrequent and occurred with a similar rate across all treatment groups in the different studies.

• In light of results from Phase II and III trials, aflibercept is a well-tolerated drug with a safety profile similar to other intraocular anti-VEGF treatments; compared with ranibizumab, the safety profile was similar.

Notes