Drug reference
Aflibercept is a recombinant fusion protein that acts as a soluble decoy receptor and binds to vascular endothelial growth factors A and B (VEGF-A, VEGF-B) and placental growth factor (PlGF). Aflibercept inhibits the activation of VEGF receptors and the proliferation of endothelial cells, thereby inhibiting the growth of new vessels.
PDF page 1274
Neovascular (wet) age-related macular degeneration (specialist use only) ▶BY INTRAVITREAL INJECTION ▶Adult: Initially 2 mg once a month for 3 months, then 2 mg every 2 months, review treatment frequency after 12 months Macular oedema secondary to retinal vein occlusion (specialist use only) ▶BY INTRAVITREAL INJECTION ▶Adult: Initially 2 mg once a month until maximum visual acuity is achieved or there are no signs of disease activity (discontinue treatment if no improvement in visual and anatomic outcomes) Diabetic macular oedema (specialist use only) ▶BY INTRAVITREAL INJECTION ▶Adult: Initially 2 mg once a month for 5 months, then maintenance 2 mg every 2 months, review treatment frequency after 12 months (discontinue treatment if no improvement in visual and anatomic outcomes) Myopic choroidal neovascularisation (specialist use only) ▶BY INTRAVITREAL INJECTION ▶Adult: 2 mg for 1 dose, if visual or anatomic outcomes indicate that disease persists, additional doses may be administered; the interval between 2 doses should be greater than 1 month
PDF pages 1274, 1275
Clinical signs of irreversible ischaemic visual function loss. ocular or periocular infection. severe intra-ocular inflammation
PDF page 1275
Active systemic infection. diabetic patients with uncontrolled hypertension. discontinue treatment if stage 3 or 4 macular holes develop—consult product literature for full details. discontinue treatment in the event of a retinal break—consult product literature for full details. discontinue treatment in the event of rhegmatogenous retinal detachment—consult product literature for full details. patients at risk of retinal pigment epithelial tear. poorly controlled glaucoma. recent history of myocardial infarction. recent history of stroke. recent history of transient ischaemic attack CAUTIONS, FURTHER INFORMATION Aflibercept is given by intravitreal injection by specialists experienced in the management of this condition. There is a potential risk of arterial thromboembolic events and non-ocular haemorrhage following the intravitreal injection of vascular endothelial growth factor inhibitors. Endophthalmitis can occur after intravitreal injections— patients should be advised to report any signs of infection immediately.
PDF page 1275
NICE decisions ▶Aflibercept solution for injection for treating wet age-related macular degeneration (July 2013) NICE TA294 Aflibercept solution for injection is recommended as an option for treating wet age-related macular degeneration only if: . it is used in accordance with the recommendations for ranibizumab in NICE TA 155 and . the manufacturer provides aflibercept solution for injection with the discount agreed in the patient access scheme www.nice.org.uk/guidance/ta294 ▶Aflibercept for treating visual impairment caused by macular oedema secondary to central retinal vein occlusion (February 2014) NICE TA305 Aflibercept solution for injection is recommended as an option for treating visual impairment caused by macular oedema secondary to central retinal vein occlusion only if the manufacturer provides aflibercept solution for injection with the discount agreed in the patient access scheme. www.nice.org.uk/guidance/ta305 ▶Aflibercept for treating diabetic macular oedema (July 2015) NICE TA346 Aflibercept solution for injection is recommended as an option for treating visual impairment caused by diabetic macular oedema only if: . the eye has a central retinal thickness of 400 micrometres or more at the start of treatment and Eye . the manufacturer provides aflibercept with the discount agreed in the patient access scheme. www.nice.org.uk/guidance/ta346 ▶Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion (September 2016) NICE TA409 Aflibercept is recommended, within its marketing authorisation, as an option for treating visual impairment in adults caused by macular oedema after branch retinal vein occlusion, only if the manufacturer provides aflibercept with the discount agreed in the patient access scheme. www.nice.org.uk/guidance/ta409 ▶Aflibercept for treating choroidal neovascularisation (November 2017) NICE TA486 Aflibercept is recommended, within its marketing authorisation, as an option for treating visual impairment because of myopic choroidal neovascularisation in adults, only if the manufacturer provides aflibercept with the discount agreed in the patient access scheme. If patients and their clinicians consider both aflibercept and ranibizumab to be suitable treatments, the least costly should be used, taking into account anticipated administration costs, dosage and price per dose. www.nice.org.uk/guidance/ta486 Scottish Medicines Consortium (SMC) decisions The Scottish Medicines Consortium has advised (October 2016) that aflibercept (Eylea ®) is accepted for use within NHS Scotland in adults for the treatment of visual impairment due to myopic choroidal neovascularisation. This advice is contingent upon the continuing availability of the patient access scheme in NHS Scotland or a list price that is equivalent or lower.
PDF page 1275
→Appendix 1: aflibercept
PDF page 1275
▶Common or very common Cataract. eye discomfort. eye disorders. eye inflammation. haemorrhage. retinal pigment epithelial tear. vision disorders ▶Uncommon Lens opacity
PDF page 1275
Manufacturer recommends women use effective contraception during and for at least 3 months after treatment.
PDF page 1275
Manufacturer advises avoid unless potential benefit outweighs risk.
PDF page 1275
Manufacturer advises avoid—no information available.
PDF page 1275
Manufacturer advises caution in severe impairment (no information available).
PDF page 1275
Monitor intra-ocular pressure following injection.
PDF page 1275
For further information on administration, consult product literature.
PDF page 1275
There can be variation in the licensing of different medicines containing the same drug. Solution for Injection ▶Eylea (Bayer Plc) Aflibercept 40 mg per 1 ml Eylea 2mg/50microlitres solution for injection vials | 1 vial P £816.00
PDF page 1275
Initially 2 mg once a month for 3 months, then
First-line fragment. Read the complete Indications and Dose section above.
PDF page 1274
Initially 2 mg once a month until maximum
First-line fragment. Read the complete Indications and Dose section above.
PDF page 1274
Initially 2 mg once a month for 5 months, then
First-line fragment. Read the complete Indications and Dose section above.
PDF page 1275
2 mg for 1 dose, if visual or anatomic outcomes
First-line fragment. Read the complete Indications and Dose section above.
PDF page 1275
