“Based on our results, ziv-aflibercept seems to be a potential and cost-effective substitute for aflibercept in the same way that bevacizumab is a cost-effective substitute for ranibizumab,” Dr. Soheilian said. “Since vision improvement is the surrogate endpoint and because it is presumably safer to use a lower dose, we suggest using ziv-aflibercept 1.25 mg for treatment of DME.”
Ziv-aflibercept has the same molecular structure as aflibercept and acts by the same mechanism as a soluble decoy receptor, neutralizing all VEGF-A isoforms. In their commercially available formulations, the two products differ in osmolality, with the value being much higher for ziv-aflibercept compared with aflibercept—820 versus 250 mOsm.
“It has been shown that the higher osmolality of ziv-aflibercept may have a more damaging effect on the retina and cause retinal detachment,” Dr. Soheilian said. “However, we did not observe any such complications in our study.”
Other recent studies also show intravitreal ziv-aflibercept is safe and effective treatment without causing ocular toxicity in eyes with retinal disease, Dr. Soheilian noted.