Product information and disease description Place of product in therapy Approaches to treatment Current treatment options and standard of care

Anti-VEGF intravitreal injections

10 evidence topics · 4 sources

Anti-VEGF therapy as first-line treatment for neovascular AMD

“Anti-VEGF therapies have become first-line therapy for treating and stabilizing most cases of neovascular AMD, and a Cochrane systematic review demonstrates the effectiveness of these agents to maintain VA.” (opens the source at this quote in a new tab)
“Adverse events for all anti-VEGF agents include rare risks of arterial thromboembolic events, endophthalmitis, and elevated intraocular pressure.” (opens the source at this quote in a new tab)

NICE recommendation for anti-VEGF treatment of late AMD (wet active)

“Offer intravitreal anti-vascular endothelial growth factor (VEGF) treatment for late AMD (wet active) for eyes with visual acuity within the range specified in recommendation 1.5.6.” (opens the source at this quote in a new tab)
“Be aware that no clinically significant differences in effectiveness and safety between the different anti-VEGF treatments have been seen in the trials considered by the guideline committee.” (opens the source at this quote in a new tab)

Aflibercept 2 mg and 8 mg

“the 2-mg dose has been documented to be of similar efficacy to ranibizumab in the head-to-head phase-3 VEGF Trap-Eye: Investigation of Efficacy and Safety in Wet AMD (VIEW) trials.” (opens the source at this quote in a new tab)
“The 48-week results showed that after three monthly loading doses, aflibercept 8 mg showed achieved noninferior VA gains at 12-week and 16-week treatment intervals compared with aflibercept 2 mg at 8-week treatment intervals.” (opens the source at this quote in a new tab)
“The safety profile of aflibercept 8 mg was found to be similar to that of aflibercept 2 mg.” (opens the source at this quote in a new tab)

Ranibizumab 0.5 mg

“Ranibizumab 0.5-mg was approved by the FDA for the treatment of all subtypes of neovascular AMD, based on results from three double-masked, randomized controlled trials.” (opens the source at this quote in a new tab)
“Ranibizumab was well tolerated in randomized controlled trials with a safety profile similar to that of other anti-VEGF agents.” (opens the source at this quote in a new tab)

Bevacizumab (off-label intravitreal use)

“Because preliminary reports appeared favorable, ophthalmologists began using intravitreal bevacizumab off-label to treat MNV.” (opens the source at this quote in a new tab)
“Presently, there does not appear to be a significant difference in efficacy between ranibizumab and bevacizumab.” (opens the source at this quote in a new tab)
“A real-world analysis of 13,859 patients found that all three agents improved VA similarly over 1 year.” (opens the source at this quote in a new tab)

Brolucizumab

“Results from the HAWK and HARRIER phase 3 clinical trials showed that brolucizumab achieved its primary endpoint of noninferiority of BCVA change compared with aflibercept at week 48.” (opens the source at this quote in a new tab)
“After FDA approval, several cases of occlusive retinal vasculitis occurred after intravitreal brolucizumab injection.” (opens the source at this quote in a new tab)
“Brolucizumab is approved for use every 8 to 12 weeks after the loading period, and more frequent administration should be avoided.” (opens the source at this quote in a new tab)

Ranibizumab and aflibercept biosimilars

“In 2024, the FDA approved five biosimilars to aflibercept 2 mg as of November 2024” (opens the source at this quote in a new tab)
“All are injected intravitreally as a 2-mg solution, and the adverse events appear comparable to aflibercept.” (opens the source at this quote in a new tab)
“When used, the choice of biologic product (reference, biosimilar, or interchangeable) should be that of the treating ophthalmologist and the patient because patients may respond more favorably to one biologic over another.” (opens the source at this quote in a new tab)

Aflibercept 8 mg: participants maintaining 12-week and 16-week intervals through week 48 in PULSAR

“A total of 251 (79%) of 316 patients in the aflibercept 8q12 group and 239 (77%) of 312 patients in the aflibercept 8q16 group maintained their assigned dosing regimen up to week 48. Overall, 523 (83%) of 628 patients who received aflibercept 8 mg maintained at least 12-week dosing intervals up to week 48.” (opens the source at this quote in a new tab)
“Least squares mean change from baseline in BCVA letter score at week 48 was +6·1 (95% CI 4·6–7·6) letters in the aflibercept 8q12 group, +5·9 (4·5–7·3) letters in the 8q16 group, and +7·0 (5·6–8·5) letters in the aflibercept 2q8 group” (opens the source at this quote in a new tab)

Aflibercept 8 mg and 2 mg: serious ocular events, intraocular inflammation, and thromboembolic events in PULSAR

“Serious ocular TEAEs in the study eye occurred in 13 (1·3%) of 1009 patients” (opens the source at this quote in a new tab)
“no cases of endophthalmitis or retinal vasculitis were reported. All cases of intraocular inflammation were mild or moderate in severity.” (opens the source at this quote in a new tab)
“Eight cases of arteriothrombotic events, assessed and categorised by an Anti-Platelet Trialists’ Collaboration adjudication committee, were reported, with no clinically relevant differences observed across groups” (opens the source at this quote in a new tab)

Aflibercept: intraocular inflammation and vision loss with denominators in HAWK and HARRIER, and postmarketing occlusive event rate

“The SRC reviewed data from cases of investigator-reported IOI (60/1088 brolucizumab-treated eyes; 8/729 aflibercept-treated eyes).” (opens the source at this quote in a new tab)
“Incidence of IOI in aflibercept-treated eyes was 1.1%, with at least moderate visual acuity loss in 0.14%.” (opens the source at this quote in a new tab)
“The overall rates of moderate or severe visual acuity loss, including visual acuity loss associated with definite/probable IOI, retinal vasculitis, and/or retinal occlusion, were 7.4% (81/1088) and 7.7% (56/729) in brolucizumab- and aflibercept-treated eyes, respectively.” (opens the source at this quote in a new tab)
“A recent review of data from the postmarketing aflibercept Global Safety Database indicated that retinal arterial occlusion, vasculitis, or severe vision loss occurred at a rate of 0.9 per 10 000 aflibercept injections.” (opens the source at this quote in a new tab)