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aflibercept (Eylea)

Indications: - treatment of wet age-related macular degeneration - visual impairment caused by macular edema secondary to central retinal vein occlusion [NGC (NICE)] - may be most effective VEGF inhibitor in patients with worst baseline vision [2] - treatment of diabetic retinopathy [3] Contraindications: - may not be useful for non-proliferative diabetic retinopathy* * see clinical trials below Dosage: solution for injection Mechanism of action: - recombinant fusion protein consisting of portions of human VEGF receptor 1 & VEGF receptor 2 extracellular domains fused to the Fc portion of human IgG1 - acts as a soluble decoy receptor that binds VEGF-A & PlGF Clinical trials: - Protocol W Randomized Trial - 328 adults (399 eyes) 4 year study - moderate to severe non-proliferative diabetic retinopathy - initiating intravitreous aflibercept 2.0 mg when vision-threatening complications developed, resulted in statistically significant anatomic improvement but no improvement in visual acuity [4]

Specific

aflibercept ophthalmic (Eylea)

General

vascular endothelial growth factor (VEGF) inhibitor

References

  1. FDA NEWS RELEASE: Nov. 18, 2011 FDA approves Eylea for eye disorder in older people http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm280601.htm
  2. The Diabetic Retinopathy Clinical Research Network. Aflibercept, Bevacizumab, or Ranibizumab for Diabetic Macular Edema. N Engl J Med. 2015 Feb 18. PMID: 25692915 http://www.nejm.org/doi/full/10.1056/NEJMoa1414264 - Martin DF, Maguire MG. Treatment Choice for Diabetic Macular Edema. N Engl J Med. 2015 Feb 18. [Epub ahead of print] PMID: 25692914 http://www.nejm.org/doi/full/10.1056/NEJMe1500351
  3. FDA News Release. March 25, 2015 FDA approves new treatment for diabetic retinopathy in patients with diabetic macular edema. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm439838.htm
  4. Maturi RK, Glassman AR, Josic K et al Four-Year Visual Outcomes in the Protocol W Randomized Trial of Intravitreous Aflibercept for Prevention of Vision-Threatening Complications of Diabetic Retinopathy. JAMA. 2023;329(5):376-385 PMID: 36749332 https://jamanetwork.com/journals/jama/fullarticle/2801058
  5. aflibercept (Eylea) prescribing information http://www.regeneron.com/docs/eylea-fpi.pdf