Treatment-Resistant AMD Achieving Anatomical and Functional Gains With Aflibercept 8 mg

Treatment-Resistant AMD and Diabetic Macular EdemaWith High-Dose Aflibercept Summary

This presentation examines the management of treatment-resistant retinal conditions using high-dose aflibercept, focusing on cases where standard anti-VEGF therapy has failed to achieve optimal outcomes. The session includes pharmacokinetic modeling data from 17 aflibercept trials involving 2700 individuals, demonstrating that aflibercept 8 mg has 34.4% slower clearance from the eye compared with 2 mg, extending effective drug concentrations by 6 to 8 weeks and providing durability of 12 to 20 weeks vs standard dosing.

The presentation features 2 compelling cases: First, an 83-year-old woman with diabetic macular edema treated for 9 years, initially with laser photocoagulation and bevacizumab, then aflibercept 2 mg. After 3 1/2 years of declining response with increasing macular thickness and vision deteriorating to 20/40, switching to faricimab worsened outcomes to 20/70. Transitioning to aflibercept 8 mg produced dramatic improvement, with vision recovering to 20/40 and central thickness decreasing from more than 400 to 351 microns, maintained on 7-week intervals. The second case involves a 62-year-old woman with AMD who experienced treatment resistance with standard therapies but couldn't extend beyond 4-week intervals.

The AMD case demonstrates both the efficacy and challenges of high-dose therapy. While aflibercept 8 mg achieved complete macular drying and improved vision from 20/100 to 20/80, initial injections caused significant intraocular pressure spikes requiring paracentesis. Through dose modification using reduced volumes (0.05 to 0.06 ml of the 8 mg formulation, equivalent to 5.7 to 6.9 mg), optimal outcomes were achieved without pressure complications. Both cases illustrate that aflibercept 8 mg provides superior anatomic responses and extended durability compared with standard anti-VEGF agents, particularly valuable for patients whose condition is treatment-resistant and requires frequent injections.