Diana Do, MD

Experts discuss the practice of loading doses for newer agents and when they would consider this suitable for patients.

Perspectives on Loading Dose Recommendations for New Therapies

In this segment, the experts discuss the practice of loading doses when switching patients to aflibercept 8 mg. David Eichenbaum, MD inquires whether the experts recommend loading when transitioning patients, especially those who are already on a different treatment cadence. Kenny Fan, MD expresses hesitation in convincing patients to undergo loading when switching from a less frequent dosing schedule to aflibercept 8 mg. He highlights the challenge of persuading patients to undergo a more intensive treatment schedule, especially if they are already satisfied with their current regimen. Seenu Hariprasad, MD suggests that the decision to load depends on the specific scenario. For patients who have been on a stable regimen for an extended period, he may not opt for loading. However, for those with persistent disease activity, he considers taking advantage of loading doses for a more aggressive approach. Diana Do, MD notes that she typically reserves loading for treatment-naive patients. However, if there is substantial disease activity, she supports being aggressive with loading doses to provide patients with the best chance for vision improvement.

This summary was AI-generated and edited for clarity.

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Experts discuss the importance of fluid management, presenting a range of perspectives on managing complex cases.

Perspectives on Retinal Fluid Management

In this segment, the discussion centers around the concept of complete fluid resolution and its significance. David Eichenbaum, MD raises the question to David Brown, MD asking whether patients who have met the extension criteria and achieved complete fluid resolution at 20 or 24 weeks are genuinely benefiting from the drug by that point. David Brown responds by referring to prior studies that had strict criteria for treatment. He notes that around 15 to 20% of patients met the criteria after three doses and were done with treatment. He emphasizes the importance of understanding how many patients, especially at the 20 or 24-week mark, are truly completely dry. He continues, expressing his preference for having criteria similar to aflibercept 8 milligrams and reports, which would provide information on how many patients achieved complete fluid resolution at extended intervals. He underscores the need for accurate data to distinguish between patients who may not need further treatment and those who would benefit from ongoing therapy based on fluid status.

Experts discuss the importance of fluid management, presenting a range of perspectives on managing complex cases. 

Experts reflect on the current information available on the safety and durability of second-generation agents aflibercept 8 mg and faricimab.

Efficacy and Durability: New Therapies vs Aflibercept 2mg

In this segment, the discussion centers on the efficacy and durability of different anti-VEGF agents, specifically aflibercept 2 mg, 8 mg, and faricimab. Diana Do, MD emphasizes the challenges in making direct head-to-head comparisons between these agents, as they were not tested against each other in clinical trials with the same design. The focus shifts particularly to durability gains between therapies, highlighting the need for new clinical trials designed for such comparisons. Experts agree that increased durability while maintaining vision anatomy and perception is the gold standard of care for retinal disease therapies.

David Eichenbaum, MD raises a question about the drying efficacy of aflibercept 8 milligrams compared to aflibercept 2 mg in wet AMD. Seenu Hariprasad, MD responds, stating that there is good level-one evidence demonstrating that the second-generation agents, including aflibercept 8 mg, exhibit superior drying effects compared to the older generation agents like aflibercept 2 mg. He notes an increase in drying effect with the new generation agents and emphasizes the importance of drying in controlling vision outcomes.

5.	Experts share their real-world experience with aflibercept 8 mg.

Real-World Experiences With Aflibercept 8mg

Experts discuss their experiences with aflibercept 8 mg in the real world. Diana Do, MD mentions that, as an early adopter, she has started using aflibercept 8 mg in both treatment-naive and treatment-experienced patients. She notes a spectrum of responses, with some patients showing significant improvements in vision and reductions in retinal thickness, while others, particularly those with challenging, previously treated eyes, may still need closer follow-up. Kenny Fan, MD, MBA agrees with her, and emphasizes how aflibercept 8 milligrams will be used in a larger patient population with larger lesions, prior experience with other medications, and various comorbidities. He mentions that most of his patients on aflibercept 8 mg are in the Medicare population with neovascular age-related macular edema (nAMD), and he has been generally pleased with the results. However, he acknowledges the need for more data collection in the real-world setting, especially concerning the label extension after the initial three-month injections.

Experts share their real-world experience with aflibercept 8 mg, comparing it to its predecessor, aflibercept 2 mg.

Diana Do, MD

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