Aflibercept

Class
VEGF inhibitors
Subclass
VEGF receptor / IgG1 Fc fusion protein
Substance name
Aflibercept, VEGF-Trap, aflibercept-abzv, aflibercept-ayyh, aflibercept-jbvf, aflibercept-mrbb, aflibercept-yszy
Brand names
Eylea®, Pavblu®
Common formulations
Solution for injection
Dosage and administration
Adults patients
Age-related macular degeneration • Neovascular
•
Start at: 2 mg intravitreal q4 weeks for 3 months
•
Maintenance: 2 mg intravitreal q8 weeks
Some patients may need q4 week dosing after the first 3 months. Patients may also be treated with q12 week dosing after 1 year of effective therapy.
Diabetic macular edema
•
Start at: 2 mg intravitreal q4 weeks for 5 injections
•
Maintenance: 2 mg intravitreal q8 weeks
Some patients may need q4 week dosing after the first 5 months.
Diabetic retinopathy
•
Start at: 2 mg intravitreal q4 weeks for 5 injections
•
Maintenance: 2 mg intravitreal q8 weeks
Some patients may need q4 week dosing after the first 5 months.
Macular edema in patients with retinal vein occlusion
•
2 mg intravitreal q4 weeks
Pediatric patients
Treatment of retinopathy of prematurity
•
0.4 mg intravitreal × 1 in the eligible eye, repeated in 10 days if needed
Indications for use
Labeled indications
Adults
•
Treatment of age-related macular degeneration (neovascular)
•
Treatment of diabetic macular edema
•
Treatment of diabetic retinopathy
•
Treatment of macular edema in patients with retinal vein occlusion
Children
•
Treatment of retinopathy of prematurity
Safety risks
Contraindications
Hypersensitivity to aflibercept or its components
Active intraocular inflammation
Ocular or periocular infections
Warnings and precautions
Endophthalmitis, retinal detachment, retinal vasculitis
•
Maintain a high level of suspicion, as aflibercept has been associated with an icnreased risk of endophthalmitis and retinal detachment and, rarely, retinal vasculitis with or without occlusion.
Increased intraocular pressure
•
Maintain a high level of suspicion, as aflibercept has been associated with an increased risk of transient and sustained elevations of intraocular pressure. Monitor intraocular pressure and the perfusion of the optic nerve head.
Reactivation of retinopathy of prematurity
•
Maintain a high level of suspicion, as aflibercept may cause reactivation of abnormal angiogenesis and tortuosity in infants with retinopathy of prematurity. Monitor infants closely until retinal vascularization has completed.
Thromboembolic complications
•
Maintain a high level of suspicion, as there is a potential risk of arterial thromboembolic events after intravitreal administration of VEGF inhibitors.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
Renal replacement therapy
Any modality
•
Use acceptable. No dose adjustment required.
Hepatic impairment
Any severity
•
Use acceptable. No dose adjustment required.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: D
•
Avoid use. Use only if clearly needed. Evidence of fetal harm in animals. Advise females of reproductive potential to use effective contraception before the initial dose, during treatment, and for at least 3 months after the last dose.
Breastfeeding
Use only if benefits outweigh potential risks.
Unknown drug levels in breastfed infants.
No overt adverse effects on lactation reported.
Adverse reactions
Very common > 10%
•
Cataract, eye pain, subconjunctival hemorrhage
Common 1-10%
•
Corneal edema, corneal epithelial defects, eye floaters, eyelid swelling, hyperlacrimation, ↑ intraocular pressure, injection site hemorrhage, blurred vision, eye irritation, foreign body sensation in the eyes, injection site pain, red eyes, retinal detachment, retinal hemorrhage, vitreal detachment
Uncommon < 1%
•
Allergic reactions, retinal tear, endophthalmitis
Rare < 0.1%
•
Retinal vasculitis
Interactions
Drug(s)
Check Interactions
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