Comparative effectiveness of aflibercept for the treatment of patients with neovascular age-related macular degeneration

Abstract

Wet age-related macular degeneration (AMD) is the most common reason for vision loss in the United States. Many treatments, such as laser therapy and photodynamic therapies, have been used but their efficacy is limited. Emerging anti-vascular endothelial growth factor (VEGF) therapies are now considered the standard of care. Anti-VEGF agents inhibit angiogenesis in the eye by suppressing abnormal blood vessel growth, leading to vision improvement. Ranibizumab and bevacizumab are two examples of anti-VEGF drugs that have been approved; both showed promise based on the visual acuity scale. Aflibercept, another new therapy known to trap VEGF and inhibit multiple growth factors, is promising not only because it can be taken bimonthly based on year 1 of the VIEW trials, but it can also be extended, as demonstrated in year 2 of the VIEW trials. Based on a cost-effect analysis, aflibercept is comparable to other leading therapies. This is a review of relevant clinical trials that have proven the non-inferiority and safety of aflibercept compared to the standard of care and its unique role in the current management of wet AMD.

Keywords: VEGF; VIEW trials; aflibercept; anti-VEGF; bevacizumab; pegatanib; ranibizumab.

Figure 1

VEGF binds to the vEGFR-2 receptor, activating angiogenic response by phosphorylating domains within the receptor and below the endothelial membrane. Note: Reprinted with permission. © 2005 American Society of Clinical Oncology. All rights reserved. From: Rini BI, Small EJ. Biology and clinical development of vascular endothelial growth factor-targeted therapy in renal cell carcinoma. J Clin Oncol. 2005;23(5):1028–1043. Abbreviations: VEGF, vascular endothelial growth factor; VEGFR, VEGF receptor.