ASRS 2026: Aflibercept 8 mg holds vision gains with up to 3 fewer injections in macular edema following RVO

Aflibercept 8 mg (Eylea HD; Regeneron) sustained its week 36 visual acuity gains through week 64 while requiring up to 3 fewer injections than aflibercept 2 mg (Eylea; Regeneron) in patients with treatment-naive macular edema following retinal vein occlusion (MEfRVO), according to results from the phase 3 QUASAR trial (NCT05850520) presented at the American Society of Retina Specialists 44th Annual Scientific Meeting, held July 15-18, 2026, in Montréal, Québec, Canada.

Jordana Fein, MD, MS, of The Retina Group of Washington, presented the 64-week analysis and framed the durability question as one specific to RVO rather than borrowed from other retinal diseases. "RVO is a completely different acute ischemic condition where you have an immediate, very high VEGF load in the vitreous and into the retina," Fein said, contrasting it with the slower VEGF release seen in neovascular age-related macular degeneration and diabetic macular edema.

Why has extension been difficult in RVO?

Fein noted that the initial trials that led to approval of anti-VEGF agents in this setting, including BRAVO and CRUISE, dosed patients monthly for 6 months with no opportunity to extend early on, and that older data sets such as COPERNICUS showed vision declining once treatment frequency dropped. QUASAR, she said, is the first trial to look at extension in this population directly.

QUASAR design and 64-week outcomes

QUASAR randomly assigned patients aged 18 years or older with MEfRVO 1:1:1 to aflibercept 8 mg every 8 weeks after 3 initial monthly doses (8q8/3; n = 293), aflibercept 8 mg every 8 weeks after 5 initial monthly doses (8q8/5; n = 298), or aflibercept 2 mg every 4 weeks (2q4; n = 301). The primary end point was best-corrected visual acuity (BCVA) change from baseline to week 36; the key secondary end point was number of injections through week 64.¹

Aflibercept 8 mg met the 4-letter noninferiority margin at week 36, with a least squares mean difference versus 2q4 of –0.1 letters (95% CI, –2.0 to 1.9) for 8q8/3 and +0.8 letters (95% CI, –1.1 to 2.7) for 8q8/5 (both P <.0001). Through week 64, the least squares mean difference in injection number versus 2q4 was –3.2 (95% CI, –3.5 to –3.0) for 8q8/3 and –2.2 (95% CI, –2.4 to –2.0) for 8q8/5.¹

How far were patients extended?

At week 64, 81.4% of the 8q8/3 group and 78.5% of the 8q8/5 group had a last completed dosing interval of 12 weeks or longer, compared with 67.8% of the 2q4 group, and 40.5% of the 8q8/3 group were assigned to 20-week intervals. Nearly 3-fold fewer patients receiving aflibercept 8 mg were assigned every-4-week dosing than those receiving 2 mg (4.8% and 3.5% vs 13%).¹ The safety profile of aflibercept 8 mg was consistent with the established profile of aflibercept 2 mg.

Fein tied the extension data to what patients absorb outside the clinic, describing lost workdays and the need for a driver in a population she characterized as younger and more likely to still be employed. "The time is now to try to utilize some of these longer-duration agents, because the safety profile is the same as 2 mg, and you have the opportunity to treat your patients less frequently," she said.

Reference
1. Fein J. Aflibercept 8 mg in macular edema following retinal vein occlusion (MEfRVO): 64-week results from the QUASAR trial. Presented at: American Society of Retina Specialists 44th Annual Scientific Meeting; July 15-18, 2026; Montréal, Québec, Canada.