8 things to know about aflibercept 8 mg for retinal vascular disease

The US Food and Drug Administration (FDA) approved aflibercept 8 mg (EYLEA HD) for the treatment of patients with macular edema following retinal vein occlusion (RVO) with up to 8-week dosing after an initial dosing period last month.

The latest indication for Regeneron Pharmaceutical’s higher-dose vascular endothelial growth factor (VEGF) inhibitor included an approved monthly dosing option for patients who may benefit from resuming this dosing schedule across EYLEA HD’s previously approved indications for age-related macular degeneration (AMD), diabetic macular edema (DME), diabetic retinopathy (DR), and RVO.

In a recent Viewpoints panel discussion, a trio of experts discussed the impact of next-generation anti-VEGF therapies on the individual management of retinal vascular diseases.

The trio of Viewpoints panelists includes:

1. Sharon Fekrat, MD, FACS, FASRS, medical and surgical specialist, Duke Eye Center, and professor of ophthalmology, neurology and surgery in the Department of Ophthalmology at the Duke University School of Medicine
2. Jorge Fortun, MD, medical and surgical retina specialist, and associate professor of ophthalmology at the Baskin Palmer Eye Institute
3. John Kitchens, MD, retina specialist, Retina Associates of Kentucky EyeCare Partners

The opportunities derived from agents like aflibercept 8 mg include a more tailored and less frequent dosing regimen with uncompromised — if not improved — efficacy outcomes relative to prior iterations of anti-VEGF treatment. But its pathophysiological profile and clinical impact are more robust than just a single measure.

Here are 8 key takeaways on aflibercept 8 mg from our recent Viewpoints discussion.

1. Higher molar dosing supports faster drying and longer durability without changing treatment goals

The panel agreed that the overarching goal in treating AMD, DME, and RVO remains consistent: rapid retinal drying, followed by durable disease control with fewer injections. Aflibercept 8 mg’s four-fold higher molar dose compared with 2 mg was repeatedly framed as a practical means toward achieving that goal.

As Fortun explained, the higher dose directly influences both early anatomic response in patients and the durability of treatment.

“Having a higher molar dose in the eye really lends itself not only to real initial binding of VEGF — where we see the clinical translation of that being better drying — but then longer duration,” he said.

This clinical strategy is reflected in findings from the PULSAR and PHOTON trials, in which aflibercept 8 mg maintained visual acuity outcomes comparable to q8-week dosing while enabling 12- and 16-week treatment intervals for many patients with wet AMD and DME in each trial, respectively.

2. Predictability at extended intervals matters as much as peak efficacy

Beyond durability, the panelists emphasized the clinical value of more predictable response at longer intervals — particularly in busy retina clinics managing chronic disease.

Kitchens underscored how aflibercept’s molecular design contributes to that consistency.

“If I have a patient…and they look great at 8 weeks, but they leak at 10, then I know I can consistently take them back and keep them at 8 [weeks]…and you're not going to see them backslide to 6 [weeks],” he said.

This reliability in outcomes and maintained intervals aligns with post hoc analyses from PULSAR and PHOTON showing stable anatomic control across repeated extended dosing cycles with aflibercept 8 mg— a key factor in reducing both patient and clinic burden.

3. The structural features of aflibercept remain clinically relevant with 8 mg dosing

While newer agents introduce additional pathways, the panel reinforced that VEGF suppression alone remains effective for many patients, particularly in those with AMD. The discussion returned repeatedly to aflibercept’s high-binding affinity, VEGF trap mechanism, and low immunogenicity.

“The fact that it binds VEGF more tightly…may be responsible for why we see a little greater efficacy when you compare it to ranibizumab or bevacizumab,” Kitchens said. “You can't discount that dose matters.”

These characteristics, previously established with aflibercept 2 mg and reinforced by the 8 mg formulation, help explain why aflibercept continues to demonstrate reproducible outcomes over time.

4. Specialists are moving directly to aflibercept 8 mg rather than switching from the 2 mg formula

A notable real-world shift discussed during the roundtable was earlier adoption of aflibercept 8 mg, rather than reserving it as a switch therapy option. Fortun said he personally sees less utility for 2 mg formula as an initial treatment in retinal vascular disease today than when aflibercept 8 mg originally reached the market.

“I think oftentimes we were disappointed [with initial outcomes], and I think that we were just [practicing] that classic selection bias,” Fortun said. “We were taking the hardest [path] to treat patients. I've actually changed that if I'm reaching for aflibercept, it’s for 8 mg aflibercept.”

5. Aflibercept is affording longer dosing intervals, even for patients with high burden

Based on real-world practice, one of the most widely acknowledged benefits of aflibercept 8 mg has been its capacity to extend treatment intervals. Kitchens noted consistent success in moving patients from monthly or bimonthly injections to intervals of 12 weeks or longer, even in cases that were previously difficult to maintain on less frequent dosing.

“Take 2 mg aflibercept, for example,” Kitchens explained. “You've got a patient on 2 mg aflibercept at every 8 weeks, and you can't get them out to 10 weeks. Knowing that you have 4-fold the dose with the 8 mg, you have a great deal of confidence that you're at least going to get an extra couple of half-lives. Plus, we know that there's an additional booster of one-third, essentially. If you're an eye that metabolizes aflibercept in a standard way, your 8-week patient can go to 12 weeks on their injection interval. That's been a game changer.”

Kitchens added that for the patients with tough-to-treat disease—who are often the first to try these therapies—he did see an enhanced drying effect from aflibercept 8 mg in practice, allowing for those patients to extend their dosing intervals.

In practical terms, switching to aflibercept 8 mg can potentially provide relief for patients and families balancing complex schedules, transportation needs, or limitations in mobility. For retina specialists managing busy clinic volumes, the ability to stretch injection intervals—while maintaining disease control—can been described as a meaningful shift in both patient care and clinic efficiency.

6. Patients are achieving stable and durable anatomic control for diverse disease states

Whether used in patients with nAMD or DME, aflibercept 8 mg has shown notable consistency in achieving and maintaining anatomic improvements. Along with Kitchens, Fortun emphasized the drug’s ability to dry the retina rapidly and maintain that effect over extended intervals without the return of intraretinal or subretinal fluid.

“Obviously, we've all heard this before, but it's true,” Fortun said. “We're treating working-age individuals that have other comorbidities and so reducing the treatment burden in that population with DME, in particular, is so huge. That's where I really think that this newer, improved formulation of aflibercept really plays a role, particularly in my patients with DME.”

In some patients, they saw these improvements in retinal thickness and structure sustained beyond the approved 12- or 16-week intervals. Although they acknowledged that every patient has unique disease dynamics, for some of their patients, aflibercept 8 mg provided a more predictable and stable disease course.

“Thankfully we have trial design that that conformed more to looking at longer treatment intervals,” Fortun said. “That shows us that there is a path to getting out to 12 or 16 weeks. And I will say that it has changed my patient management in some cases. I mean, I'm still a traditional ‘pronto-type treater,’ where we treat and extend, and just extend at short intervals and get an OCT every time. But that clinical trial design really showed that perhaps there is a benefit to loading doses and that, perhaps, we should be extending out farther at the initial get go.”

This type of durable anatomic control can allow for greater flexibility in follow-up scheduling and, ultimately, may reduce the risk of disease progression associated with missed visits or treatment delays.

7. Early switches yield meaningful benefits

For patients with long-standing retinal vascular disease — some of whom had been receiving anti-VEGF injections for years — transitioning to aflibercept 8 mg can still lead to meaningful clinical gains. Kitchens and Fortun noted cases where, despite an extended treatment history, switching to the higher-dose formulation allowed for reestablishment of a dry macula and symptom relief.

Kitchens noted that he sees a tangible difference in treatment-naive patients, particularly those with treatment-naive wet AMD. “If you get somebody who neglects the disease and comes in 4 or 6 months after the onset, you're going to get a big fibrotic membrane. But in those people have smaller membranes and good visual acuity, my goodness — they dry up almost immediately after the first injection,” he said, explaining that he begins to extend those patients immediately following their second injection.

He explained he’ll begin with injection at baseline, then bring them back after 1 month and inject again with 8 mg if there’s full dryness, and then bring them back again 2 months later, repeating that assessment. This “stopover,” as Kitchens said, is aimed at getting patients out to an 8-week interval quicker, rather than going right out to 12 weeks. “I'm amazed by how many new onsets, with early smaller CNVMs with wet AMD do amazingly well with that product protocol,” he said.

The discussion reinforced the idea that aflibercept 8 mg is not only for treatment-naïve patients but can also play a significant role in re-optimizing disease management in previously treated eyes. In patients who have plateaued on other regimens, aflibercept 8 mg can help recapture control, especially when persistent or recurrent fluid has become a challenge.

8. Patient satisfaction and practice flow benefits are baked in

Beyond the clinical end points, Kitchens and Fortun reported improved satisfaction among patients treated with aflibercept 8 mg—driven primarily by reduced injection burden and the feeling of improved disease stability. Patients expressed appreciation for not having to come into the clinic as frequently, especially those who rely on caregivers or face long commutes.

“It's the patient conversation that is a real differentiator,” Kitchens said. “If you tell a patient, ‘I'm going to switch you to a different medicine,’ you get questions, like, ‘What's the medicine? How's it work?’ If you say, ‘Hey, they came out with a new version of the medicine you're already on, it's like an upgrade. Just like having a cell phone that has a larger battery, it's going to last longer. It's the same aflibercept you know and love, that you've been getting for years in your eye, it's just a higher concentration, little bit higher volume, of medicine, but they've concentrated it so that it's not going to be 4 times the volume, it's just 4 times the dose, and I believe it's going to last longer for you.’ I've not had a single patient ‘Go, tell me more about this,’ they just say, ‘Great. Do I get it today?’”

From a practice management standpoint, the ability to safely stretch injection intervals has downstream benefits for clinic flow. Fewer urgent reinjections, reduced rescheduling from fluid recurrence, and more predictable maintenance plans allow for more streamlined resource allocation. For retina specialists in high-volume settings, this can translate to operational efficiencies without sacrificing quality of care.