Switching to Aflibercept 8 mg in Treatment-Experienced Patients with Ted Leng, MD

At the 2025 Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting, Theodore Leng, MD, Director of Clinical and Translational Research and Director of Ophthalmic Diagnostics at Stanford University School of Medicine, presented an analysis of using aflibercept 8 mg in eyes with neovascular age-related macular degeneration (nAMD) upon switching from other anti-VEGF agents.

“I’m really excited about this study because it is a real-world data study which allows us an insight into how aflibercept 8 mg is being used in the AMD and DME population since it launched,” Leng told HCPLive. “The other exciting part about this study is that we combined data from two separate real-world data sets. And from that, we had data from almost 40,000 aflibercept 8 mg patients to provide early insights into the effectiveness of this medication in everyday clinical practice.”

The study created multiple cohorts of previously treated eyes with nAMD from electronic records in Intelligent Research in Sight (IRIS) and Vestrum Health Retina Database (Vestrum). Eyes initiating aflibercept 8 mg from August 18, 2023 to June 30, 2024 (IRIS) and August 18, 2023, to July 30, 2024 (Vestrum) were followed from initiation until last visit, real-world treatment (tx) switch, or missing tx laterality information.1

Mean dosing intervals were calculated during the pre-aflibercept 8 mg switch period (≥6 months up to 1 year); loading phase, defined as the first 3 injections or 90 days, whichever occurred first; and post-loading phase, defined as the end of follow-up. Dosing intervals were examined before and after switching in a subset of eyes that were consistently anti-VEGF-treated prior to switch with average dosing intervals before switching of 4-≤6 or 6-≤8 weeks. Consistency was defined as tx for ≥6 months and average dosing intervals of ≤8 weeks.1

The trial collected a total of 25,846 and 9480 eyes initiating aflibercept 8 mg from IRIS and Vestrum, respectively. The mean age of these patients was 81 years; roughly 40% were men and 49% had bilateral nAMD. Approximately 71% switched from aflibercept 2 mg and 18% from faricimab.1

Consistently anti-VEGF treated eyes with ≥1 post-loading phase injection (IRIS n = 7256; Vestrum n = 1814), the last post-loading dosing interval was on average (mean standard deviation [SD]) 16 (18) and 18 (17) days longer than last observed interval prior to switch, respectively. Consistently anti-VEGF-treated eyes with average pre-switch injection intervals of 4-≤6 weeks in IRIS (n = 3577) and Vestrum (n = 801), dosing intervals were extended by 19 (17) and 21 (15) days, respectively. Eyes with an average pre-switch injection interval of 6-≤8 weeks in IRIS (n = 3628) and Vestrum (n = 1013), mean interval extension was 12 (19) and 16 (18) days, respectively.1

Leng and colleagues noted that these data suggest dosing intervals could be extended by 2 or more weeks among nAMD eyes that had received consistent anti-VEGF treatment prior to beginning aflibercept 8 mg.1

“Typically, the most common reason for switching is a lack of efficacy or suboptimal treatment response, or the desire to have longer treatment intervals between the injections. And so, while we did see less extension in the patients that were not being dosed as frequently, it was still a significant time increase in treatment,” Leng said. “If your goal is to have fewer visits, that can come from either the patient side or from a clinical flow operational side, from the physician side. Then even patients who are only going to get a few more weeks might still be worth to consider switching.”

Leng reports the following disclosures: Astellas, Boehringer Ingelheim, Regeneron Pharmaceuticals, Inc., Roche/Genentech, Topcon, Virtual Field

References

1. Leng, T, Sherman, S, Murdock, D, et al. Early insights from real-world use of aflibercept 8 mg among eyes with neovascular age-related macular degeneration (nAMD) switching from other anti-VEGF agents. Abstract presented at Association for Research in Vision and Ophthalmology in Salt Lake City, UT, from May 3 – May 8, 2025.