Aflibercept in Wet AMD Beyond the First Year of Treatment
Guidance on the management of wet AMD in the UK has been published by NICE and the Royal College of Ophthalmologists (RCO). It should be noted that the product label for ranibizumab has been changed since the RCO guidance was published, and therefore these guidelines are not presented below.
According to the NICE July 2013 technology appraisal (TA294), aflibercept is recommended as an option for treating wet AMD if it is used in accordance with the NICE recommendations for ranibizumab and offered at the discount agreed in the patient access scheme. The criteria for ranibizumab use (based on the NICE technology appraisal re-issued in May 2012; TA155) are as follows: best-corrected visual acuity (BCVA) between 6/12 and 6/96; no permanent damage to the central fovea; lesion size ≤12 disc areas in greatest linear dimension; and evidence of disease progression.
For ranibizumab, the label states that treatment should be given monthly until maximum VA is achieved and/or there are no signs of disease activity. Monitoring and treatment intervals can be extended thereafter. The treatment interval should be extended by no more than 2 weeks at a time in wet AMD.
As outlined above, aflibercept treatment (2 mg) is initiated with one injection per month for 3 months. Thereafter, treatment continues at 2-monthly injections for the remainder of Year 1 (Table 1).
Management of Wet AMD in the UK
Guidance on the management of wet AMD in the UK has been published by NICE and the Royal College of Ophthalmologists (RCO). It should be noted that the product label for ranibizumab has been changed since the RCO guidance was published, and therefore these guidelines are not presented below.
NICE Technology Appraisals on Ranibizumab and Aflibercept in Wet AMD
According to the NICE July 2013 technology appraisal (TA294), aflibercept is recommended as an option for treating wet AMD if it is used in accordance with the NICE recommendations for ranibizumab and offered at the discount agreed in the patient access scheme. The criteria for ranibizumab use (based on the NICE technology appraisal re-issued in May 2012; TA155) are as follows: best-corrected visual acuity (BCVA) between 6/12 and 6/96; no permanent damage to the central fovea; lesion size ≤12 disc areas in greatest linear dimension; and evidence of disease progression.
Treatment Posology in the First Year of Wet AMD Therapy
For ranibizumab, the label states that treatment should be given monthly until maximum VA is achieved and/or there are no signs of disease activity. Monitoring and treatment intervals can be extended thereafter. The treatment interval should be extended by no more than 2 weeks at a time in wet AMD.
As outlined above, aflibercept treatment (2 mg) is initiated with one injection per month for 3 months. Thereafter, treatment continues at 2-monthly injections for the remainder of Year 1 (Table 1).
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