Intravitreal aflibercept: its role in treatment of neovascular age-related macular degeneration

Introduction: Age related macular degeneration (AMD) affects over 14 million people worldwide and is the commonest cause of visual loss in the over 65' s age group in the industrialised world. The neovascular form of AMD (nAMD) is responsible for the majority of severe visual loss. The introduction of anti-vascular endothelial growth factor (anti-VEGF) agents in the mid 2000' s revolutionised the treatment of nAMD. Of the current three anti-VEGF agents widely used, Aflibercept (EYLEA (R); Regeneron Pharmaceutical Inc., Tarrytown, NY, USA/Bayer Healthcare, Berlin, Germany) was the latest to be introduced. Areas covered: The different forms of AMD and previous treatments for nAMD are described. Current treatment regimens using anti-VEGFs are reviewed with particular emphasis on aflibercept, its specific properties and dosing strategies. Expert commentary: Clinical trials demonstrated that aflibercept achieved the same results using an 8 weekly dosing regimen, compared to a 4 weekly ranibizumab regimen. This reduction in injection frequency reduces hospital visits, thus benefiting patients and hospital eye services. Different treatment regimens including 'as required', and 'treat and extend' protocols have enabled further reductions in injection frequency, but with careful monitoring to avoid visual loss. Further developments are required to identify those who need fewer injections. The introduction of longer lasting, or topical agents, or strategies for primary prevention represent potential future developments.