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Publications

Journal Article Review Ahead of print

PubMed: 42567877 DOI: 10.1038/s41433-026-04779-5

Aflibercept 8 mg in neovascular age-related macular degeneration and diabetic macular oedema: Translating clinical trials into clinical practice.

Eye (Lond)

Authors: Sobha Sivaprasad, Michael W Stewart, Charles C Wykoff, David Eichenbaum, Jean-Francois Korobelnik, Paolo Lanzetta, Varun Chaudhary, Chui Ming Gemmy Cheung, Richard Gale, Marion R Munk, Taiji Sakamoto, Andreas Stahl, Javier Zarranz-Ventura, Tien Yin Wong, Frank G Holz, Anat Loewenstein

Affiliations

  • NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
  • Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA.
  • Retina Consultants of Texas, Retina Consultants of America, Houston, TX, USA.
  • Retina Vitreous Associates of Florida, Saint Petersburg, FL, USA.
  • Morsani College of Medicine at the University of South Florida, Tampa, FL, USA.
  • CHU Bordeaux, Service d'Ophtalmologie, Bordeaux, France.
  • University of Bordeaux, INSERM, BPH, UMR1219, Bordeaux, France.
  • Department of Medicine-Ophthalmology, University of Udine, Udine, Italy.
  • Istituto Europeo di Microchirurgia Oculare-IEMO, Udine, Italy.
  • Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
  • Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, ON, Canada.
  • Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
  • Duke-National University of Singapore Medical School Singapore, Singapore, Singapore.
  • Hull York Medical School, University of York, York, UK.
  • Hull York Medical School, University of York, and York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK.
  • Gutblick Practise Group, Pfäffikon, Switzerland.
  • Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
  • Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
  • Department of Ophthalmology, Kagoshima University, Kagoshima, Japan.
  • Department of Ophthalmology, University Medicine Greifswald, Mecklenburg-Vorpommern, Greifswald, Germany.
  • Hospital Clínic de Barcelona, Barcelona, Spain.
  • Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine, and Health Sciences, Universitat de Barcelona, Barcelona, Spain.
  • Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
  • Beijing Visual Science and Translational Eye Research Institute (BERI), Beijing Tsinghua Changgung Hospital, Beijing, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China.
  • School of Biomedical Engineering, Tsinghua Medicine, Tsinghua University, Beijing, China.
  • Department of Ophthalmology and GRADE Reading Center, University of Bonn, Bonn, Germany.
  • Department of Ophthalmology, Tel Aviv Medical Centre, Tel Aviv, Israel.

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.

MeSH

Macular Degeneration, Ophthalmology, Translating, Therapeutics