Analysis the frequency of using Aflibercept (8 mg) in the treatment of neovascular age-related macular degeneration and diabetic macular edema compared with other anti-VEGF agents

Purpose. This study aimed to evaluate the frequency of use of the drug aflibercept in the form of a 114.3 mg/mL, 0.263 mL solution for injection (hereinafter aflibercept 8 mg), compared with alternative anti-VEGF agents in adult patients with neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) over a long-term period (2 years). Material and methods. A review of the literature was conducted to assess the frequency of administration of anti-VEGF drugs included in the Vital and Essential Drugs (VED) list as of 01.10.2025. Based on the results of published studies, an indirect comparison was performed evaluating the frequency of administration of aflibercept (114.3 mg/mL, 0.263 mL) with ophthalmic drugs used in clinical practice (aflibercept 40 mg/mL, 0.278 mL; brolucizumab 120 mg/mL, 0.23 mL; ranibizumab 10 mg/mL, 0.23 mL) in patients with nAMD and DME over 2 years of therapy. The difference in the number of injections should be interpreted as follows: a negative value indicates fewer injections of aflibercept 8 mg compared with brolucizumab 6 mg and ranibizumab 0.5 mg, while a positive value corresponds to fewer injections when compared with aflibercept 2 mg (as accepted in the original publication). If the difference in frequency of drug administration was statistically significant, additional assessments were performed: the potential number of avoided injections when using a less frequent dosing regimen, and the potential number of additional patients who could receive such treatment. Results. Aflibercept 8 mg administered in dosing intervals extended up to 24 weeks for patients with nAMD was associated with a statistically significant reduction in the number of injections compared with aflibercept 2 mg: 2.37 (95% CI: 1.88 to 2.86) and 2.6 (95% CI: 2.11 to 3.09); with brolucizumab 6 mg: –1.82 (95% CI: –2.8 to –0.8) and –1.7 (95% CI: –3.0 to –0.4); with ranibizumab 0.5 mg: –7.17 (95% CI: –8.5 to –5.9) and –3.15 (95% CI: –3.7 to –2.6) in the first and second year, respectively. Aflibercept 8 mg administered in dosing intervals extended up to 24 weeks for patients with DME was associated with a statistically significant reduction in the number of injections compared with aflibercept 2 mg: 3.57 (95% CI: 3.1 to 4.0) and 2.7 (95% CI: 2.1 tot 3.3); with brolucizumab 6 mg: –1.97 (95% CI: –2.5 to –1.4) and –1.56 (95% CI: –2.2 to –1.0) in the first and second year, respectively. In a similar comparison between aflibercept 8 mg and ranibizumab 0.5 mg (extended-interval regimen) in DME patients, the difference in the number of injections was 5.7 injections in both the first and second year; however, the value was calculated without determining the confidence interval (CI), which is a limitation of this study. Conclusions. The use of aflibercept 8 mg in the treatment of nAMD and DME demonstrates a reduction in the number of intravitreal injections, accompanied by a significant reduction in the socioeconomic burden.