Aflibercept 8 mg in neovascular age-related macular degeneration and diabetic macular oedema: Translating clinical trials into clinical practice
Abstract
Abstract Provide expert-informed guidance on the integration of aflibercept 8 mg into routine clinical care for patients with neovascular age-related macular degeneration (nAMD) and diabetic macular oedema (DMO), based on clinical trial and real-world evidence. Sixteen retina specialists (‘experts’) met during the Association for Research in Vision and Ophthalmology (ARVO) annual meeting in May 2025 to discuss the clinical use of aflibercept 8 mg. A post-meeting online platform was used to collect additional independent input. Agreement was captured using binary responses and categorised as: all agreed (100%), majority agreed ( ≥ 75%), most agreed (50–74%), or non-consensus ( ≤ 50%). All experts agreed that aflibercept 8 mg may be considered as a first-line treatment in treatment-naïve patients with nAMD and DMO, and switching to aflibercept 8 mg can be considered for previously treated patients. The majority of experts agreed that switching patients with well-controlled disease on shorter or intermediate dosing intervals may enable further interval extension while maintaining disease control, and switching patients with poorly controlled disease may optimise anatomical outcomes and improve stability. Most experts agreed that three initial monthly loading doses are appropriate in newly diagnosed patients. No consensus was reached on optimal dosing-decision strategies after switching in patients with poorly controlled disease, nor on the timing of initial interval modification during treatment initiation. These expert opinions, informed by available, emerging clinical evidence and real-world clinical experience, support aflibercept 8 mg as a first-line and switch option for nAMD and DMO, using personalised treatment approaches for both treatment-naïve and previously treated patients.
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Authors: Sobha Sivaprasad, Michael W. Stewart, Charles C. Wykoff, David Eichenbaum, Jean‐François Korobelnik, Paolo Lanzetta, Varun Chaudhary, Chui Ming Gemmy Cheung, Richard P. Gale, Marion R. Munk, Taiji Sakamoto, Andreas Stahl, Javier Zarranz‐Ventura, Tien Yin Wong, Frank G. Holz, Anat Loewenstein
Institutions: Northwestern University, University of South Florida, University College London, Inserm, National University of Singapore, WinnMed, University of Bern, University of Bonn, Tsinghua University, University of York, Université de Bordeaux, Hospital Clínic de Barcelona, Universitat de Barcelona, Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, Tel Aviv University, McMaster University, University Hospital of Bern, Beijing Tsinghua Chang Gung Hospital, University of Udine, Hull York Medical School, Kagoshima University, Mayo Clinic in Florida, Universitätsmedizin Greifswald, Moorfields Eye Hospital NHS Foundation Trust, Moorfields Eye Hospital, Retina Consultants of Texas, Retina Vitreous Associates of Florida, Centre Hospitalier Universitaire de Bordeaux, Bordeaux Population Health, Istituto Europeo di Microchirurgia Oculare, Impact, Singapore National Eye Center, Singapore Eye Research Institute, York Teaching Hospital NHS Foundation Trust, Institute of Sustainable Development of Landscapes of the Earth