Pharmacologic class: Vascular endothelial growth factor (VEGF) inhibitor
Therapeutic class: Ophthalmic agent
Pregnancy risk category C
VEGF-A and placental growth factor (PlGF) are members of the VEGF family of angiogenic factors that can act as mitogenic, chemotactic, and vascular permeability factors for endothelial cells. VEGF acts via two receptor tyrosine kinases, VEGFR-1 and VEGFR-2, present on the surface of endothelial cells. PlGF binds only to VEGFR-1, which is also present on the surface of leucocytes. Activation of these receptors by VEGF-A can result in neovascularization and vascular permeability. Aflibercept acts as a soluble decoy receptor that binds VEGF-A and PlGF, and thereby can inhibit the binding and activation of these cognate VEGF receptors.
Solution for ophthalmic injection: 40 mg/ml in 3-ml (0.278-ml fill) single-use vials
Indications and dosages
➣ Neovascular (wet) age-related macular degeneration
Adults: 2 mg (0.05 ml) by intravitreal injection into affected eye q 4 weeks for the first 3 months, followed by 2 mg (0.05 ml) once q 8 weeks
• Hypersensitivity to drug or its components
• Ocular or periocular infection
• Active intraocular inflammation
Use cautiously in:
• pregnant or breastfeeding patients
• children (safety and efficacy not established).
• Be aware that drug should be administered by ophthalmic intravitreal injection only under controlled aseptic conditions by a qualified health care professional.
• Provide adequate anesthesia and a topical broad-spectrum anti-infective before the injection, as prescribed.
• Inspect drug for particulate matter and discoloration before administering.
• Use a filter needle to draw up the prescribed dose; remove the filter needle from syringe, and attach a 30G, ½-inch injection needle for the intravitreal injection. Discard unused drug after injection.
• Be aware that each vial should only be used for the treatment of a single eye. If the contralateral eye requires treatment, use a new vial and change all equipment.
• Immediately following the intravitreal injection, assess patient for increased intraocular pressure (IOC).
CNS: nonfatal stroke
CV: nonfatal MI, vascular death
EENT: conjunctival hyperemia, conjunctival hemorrhage, eye pain, cataract, vitreous detachment, vitreous floaters, increased IOC, endophthalmitis, corneal erosion, corneal edema, retinal detachment, retinal tear, retinal pigment epithelium tear, injection-site pain, injection-site hemorrhage, foreign body sensation in eye, increased lacrimation, blurred vision, eyelid edema
• Continue to monitor patient for increased IOP, endophthalmitis, retinal detachment, and arterial thromboembolic events and be prepared to treat appropriately.
☞ Instruct patient to contact ophthalmologist immediately if treated eye becomes red, light sensitive, or painful, or if vision change occurs.
☞ Instruct patient to immediately report signs and symptoms of stroke (such as weakness on one side of body or slurred speech), chest pain, or other new signs and symptoms.
• Caution patient to avoid driving and other hazardous activities until visual function has recovered sufficiently.
• As appropriate, review all other significant and life-threatening adverse reactions mentioned above.