title: Treatment of Exudative Age-related Macular Degeneration: Focus on Aflibercept.
abstract: A formulation of aflibercept for intravitreal injection (Eylea) is approved for the treatment of patients with exudative age-related macular degeneration (AMD). Aflibercept has a significantly higher affinity for Vascular endothelial growth factor (VEGF)-A compared with other monoclonal anti-VEGF antibodies. In addition to binding all VEGF-A isoforms, aflibercept also blocks other proangiogenic factors such as VEGF-B and placental growth factor. The VIEW 1 and 2 trials showed this drug achieves improved results in patients with exudative AMD similar to those obtained with monthly ranibizumab, using a bimonthly treatment regimen after a loading dose of three intravitreal injections, which translates to less use of healthcare resources. There is a subgroup of patients that present with persistent fluid after the loading dose that could benefit from monthly injections or personalized proactive treatment after the first year. In the second year of treatment, the Treat and Extend patterns can permit even more lengthening of the time between injections. More data are needed to confirm the optimal monitoring and retreatment dosing, to maintain long-term efficacy. Other preliminary data suggest that patients that do not respond to other anti-angiogenics and patients with special pathologies such as polypoidal choroidopathy or retinal angiomatous proliferation can improve upon switching to aflibercept. To date, the safety profile of aflibercept is excellent and is comparable to other anti-angiogenic treatments.
authors.affiliation: Department of Ophthalmology, Clinica Universidad de Navarra, Pio XII 36, 31080, Pamplona, Navarra, Spain. aglayana@unav.es.|Sociedad Española de Retina y Vítreo (SERV), Red Temática de Investigación Cooperativa Oftared, Instituto de Salud Carlos III, Madrid, Spain. aglayana@unav.es.
authors.forename: Alfredo
authors.initials: A
authors.lastname: García-Layana
authors.affiliation: Sociedad Española de Retina y Vítreo (SERV), Red Temática de Investigación Cooperativa Oftared, Instituto de Salud Carlos III, Madrid, Spain.|Vissum Madrid, Department of Retina and Vitreous, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: Marta S
authors.initials: MS
authors.lastname: Figueroa
authors.affiliation: Sociedad Española de Retina y Vítreo (SERV), Red Temática de Investigación Cooperativa Oftared, Instituto de Salud Carlos III, Madrid, Spain.|Ophthalmology Service, Hospital San Eloy, Barakaldo, Bizcaia, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Araiz
authors.affiliation: Sociedad Española de Retina y Vítreo (SERV), Red Temática de Investigación Cooperativa Oftared, Instituto de Salud Carlos III, Madrid, Spain.|Instituto Europeo de la Retina, Clínica Baviera, Universidad de Castilla La Mancha, Albacete, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Ruiz-Moreno
authors.affiliation: Sociedad Española de Retina y Vítreo (SERV), Red Temática de Investigación Cooperativa Oftared, Instituto de Salud Carlos III, Madrid, Spain.|Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, A Coruña, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Gómez-Ulla
authors.affiliation: Sociedad Española de Retina y Vítreo (SERV), Red Temática de Investigación Cooperativa Oftared, Instituto de Salud Carlos III, Madrid, Spain.|Ophthalmology Service, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Arias-Barquet
authors.affiliation: Department of Ophthalmology, Clinica Universidad de Navarra, Pio XII 36, 31080, Pamplona, Navarra, Spain.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Reiter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology*; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism; D057135:Wet Macular Degeneration / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D011993:Recombinant Fusion Proteins; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab