title: Aflibercept: a review of its use in the treatment of choroidal neovascularization due to age-related macular degeneration.
abstract: Choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) is an important cause of visual morbidity globally. Modern treatment strategies for neovascular AMD achieve regression of CNV by suppressing the activity of key growth factors that mediate angiogenesis. Vascular endothelial growth factor (VEGF) has been the major target of neovascular AMD therapy for almost two decades, and there have been several intravitreally-administered agents that have enabled anatomical restitution and improvement in visual function with continual dosing. Aflibercept (EYLEA(®)), initially named VEGF Trap-eye, is the most recent anti-VEGF agent to be granted US Food and Drug Administration approval for the treatment of neovascular AMD. Biologic advantages of aflibercept include its greater binding affinity for VEGF, a longer intravitreal half-life relative to other anti-VEGF agents, and the capacity to antagonize growth factors other than VEGF. This paper provides an up-to-date summary of the molecular mechanisms mediating CNV. The structural, pharmacodynamic, and pharmacokinetic advantages of aflibercept are also reviewed to rationalize the utility of this agent for treating CNV. Results of landmark clinical investigations, including VIEW 1 and 2 trials, and other important studies are then summarized and used to illustrate the efficacy of aflibercept for managing treatment-naïve CNV, recalcitrant CNV, and CNV due to polypoidal choroidal vasculopathy. Safety profile, patient tolerability, and quality of life measures related to aflibercept are also provided. The evidence provided in this paper suggests aflibercept to be a promising agent that can be used to reduce the treatment burden of neovascular AMD.
authors.affiliation: Vitreous-Retina-Macula Consultants of New York, NY, USA ; LuEsther T Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA ; Centre for Ophthalmology and Visual Sciences, Lions Eye Institute, University of Western Australia, Perth, WA, Australia.
authors.forename: Chandrakumar
authors.initials: C
authors.lastname: Balaratnasingam
authors.affiliation: Vitreous-Retina-Macula Consultants of New York, NY, USA ; LuEsther T Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA ; Department of Ophthalmology, Edward S Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Elona
authors.initials: E
authors.lastname: Dhrami-Gavazi
authors.affiliation: Vitreous-Retina-Macula Consultants of New York, NY, USA ; LuEsther T Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA ; Department of Ophthalmology, Edward S Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, NY, USA ; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA.
authors.forename: Jesse T
authors.initials: JT
authors.lastname: McCann
authors.affiliation: Vitreous-Retina-Macula Consultants of New York, NY, USA ; LuEsther T Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA.
authors.forename: Quraish
authors.initials: Q
authors.lastname: Ghadiali
authors.affiliation: Vitreous-Retina-Macula Consultants of New York, NY, USA ; LuEsther T Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA ; Department of Ophthalmology, Edward S Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, NY, USA ; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA.
authors.forename: K Bailey
authors.initials: KB
authors.lastname: Freund
keywords: aflibercept; age-related macular degeneration; choroidal neovascularization; clinical trial; vascular endothelial growth factor