Switching Patients From 2mg to 8mg Aflibercept for nAMD and DME Treatment


Retina specialists comment on switching patients from 2 mg to 8 mg of aflibercept for the management of neovascular age-related macular degeneration and diabetic macular edema and transitioning a patient who has good control with aflibercept to a newer therapy.

Rishi P. Singh, MD: Have you had experience with 8 mg of aflibercept to date? What has been your experience? Have you seen any differences as far as the 2 mg that you saw in the past?

M. Ali Khan, MD, FACS, FASRS:It’s very early relative to faricimab because of the more recent approval. It’s a little different because people I’m using it [for], at least to start, are people who’ve been doing OK on our current of aflibercept dose of 2 mg and are trying to see whether we can go longer with the longer interval. So I am, similar to what you mentioned before with faricimab, starting to see some longer intervals in patients who are currently on anti-VEGF [therapy], but I haven’t had enough experience with treatment-naive patients or a significant number of patients [with] recalcitrant [disease] to see whether it’s making a difference in terms of real-world outcomes. But for patients who are already on aflibercept 2 mg, it’s an easy switch to consider simply because it’s the same molecule and the patients are comfortable with the drug that they’re on. So I’m interested to see what your and other people’s experience is [with] that switch, even with the same drugs [at] the higher dose.

Rishi P. Singh, MD: It’s early for these drugs. I don’t know whether I could make a comment about the efficacy of 8 mg thus far, but thus far we haven’t seen the safety concerns that we had in the past with other drugs, not anything in this realm but certainly with other drugs in the brolucizumab era and other drugs that were there. We don’t see that, which is very reassuring, but [in terms of] efficacy, we’re still waiting on new confidence over the next year or so for the data we’re seeing with our patients over time. For a patient who [has good control] in a regimen of 3 to 4 injections annually, what are your thoughts on transitioning them to these newer therapies?

M. Ali Khan, MD, FACS, FASRS: To be perfectly honest, if somebody’s already on quarterly treatments or every 3 to 4 months, I’d probably [be] unlikely to switch those patients at this stage. [Because of] some of the things that you mentioned outside the clinical realm, including cost and considerations such as that, if they’re already on [treatment] every 12 to 16 weeks, I’m unlikely to rock the boat [for] those patients to get a little bit longer [benefit], partially because I still want to check on these patients…to make sure they’re doing OK overall, [that] there [are] no clinical examination findings that are concerning [or] changing. So those patients I’m more likely to keep [on treatment], but [for] treatment-naive [patients] and patients who have never achieved that 10-week interval, [I’m] more interested in seeing how that switch works out.

Rishi P. Singh, MD: I agree with you there. Those patients who’ve had quarterly injections, they’re on a good clip there. They may see an incremental benefit of just a few weeks. You’re having this other side of it, which [is that] you don’t want to extend [treatment] too far because you want to watch them. And these patients have fellow eye disease too; sometimes you have to watch their fellow eyes to see whether they [experience progression]. And that would be a good reason to bring them in earlier. But I agree with you. I’m transitioning those patients who are in the Q4 [or] Q6 category for aflibercept now to other drugs with a greater durability regimen because that would be helpful to understand better what the benefits may be of those drugs and those high-treatment populations.

Transcript is AI generated and edited for clarity and readability.

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