Summary

Aflibercept (Eylea®) is a recombinant fusion protein which binds to and inhibits activation of vascular endothelial growth factor (VEGF-A) and Placental Growth Factor (PIGF) receptors, and is approved for use in the EU to treat adults with wet age related macular degeneration (AMD). Aflibercept has been evaluated for the treatment of wet AMD in two large studies against the current therapy recommended by NICE, ranibizumab. It was demonstrated that intravitreal aflibercept (every two months after three consecutive monthly doses) was non-inferior to monthly intravitreal ranibizumab at 52 weeks with the possibility that effectiveness continues for up to 2 years with as needed dosing. Efficacy beyond two years will be established with longer term studies which are still on-going. Aflibercept offers an alternative treatment option in the UK to existing NICE approved treatment ranibizumab. Clinical evidence in those patients who require frequent retreatment or have failed previous therapy with ranibizumab is limited as patients receiving prior treatment for wet AMD were excluded from the licensing trials. Benefits postulated for aflibercept over ranibizumab include reduced frequency of drug administration and monitoring (see critical evaluation for further discussion). Aflibercept is competitively priced in comparison to ranibizumab (first year cost, £5712 vs. £5937, based on 8 injections per year). However, this depends on the frequency of ranibizumab injections used which will vary i