Switch From 2mg Aflibercept to 8mg Aflibercept in Patients With Neovascular Age-related Macular Degeneration

Aflibercept 8 mg was recently approved by the European Medicines Agency (EMA) for the treatment of neovascular age-related macular degeneration (nAMD). The higher dosage promises prolongation of treatment intervals up to 16 weeks. Only limited clinical data is available on switching from so-called suboptimal or non-responders. A retrospective analysis showed that aflibercept in 3 mg or 4 mg doses can improve outcomes in patients who do not respond optimally to aflibercept 2 mg. It remains unclear whether switching to the above-mentioned and newly approved aflibercept 8 mg will prolong treatment intervals and stabilize visual acuity in patients who are not treatment-naive.

The present study is a single-center observational study. The plan is to include 50 eyes from 50 patients who have previously received aflibercept 2 mg injections. Patients receive a routine 8 mg aflibercept injection in the eye clinic based on the existing treat-extend regimen. At each visit, a visual acuity test, optical coherence tomography (OCT) imaging, and a standard slit lamp examination with fundoscopy are performed. The injection interval is extended by two weeks. If the two-week extension leads to deterioration, the interval is shortened by two weeks. Patients are monitored in the study for 12 months.

Inclusion criteria

• Patients, who received prior intravitreal anti-VEGF-treatment for nAMD with Aflibercept 2mg. A minimum of four injections of Aflibercept 2mg is required. Therefore 16-24 weeks prior treatment with anti-VEGF is required in line with an interval of 4-8 weeks.
• Short treatment intervals of 4 or 8 weeks
• nAMD
• Age 21 or older
• Written informed consent

Exclusion criteria

• Chronic treatment with Bevacizumab or Faricimab
• Extensive macular fibrosis
• Diabetic retinopathy
• Other retinal pathologies (e.g. retinal vein occlusion)
• Dense media opacities (cataract, corneal scars)
• Vitreous hemorrhage
• Ocular or periocular infections
• Active intraocular inflammation
• Hypersensitivity to the active substance or to any of the excipients
• Prior Aflibercept 8mg treatment
• Pregnancy (for women in reproductive age a pregnancy test will be performed)