What to Know About Eylea (Aflibercept)

Eylea (aflibercept) is an injectable medication used for the treatment of certain eye conditions, which include macular edema, wet age-related macular degeneration (AMD), and diabetic retinopathy (DR).

The medication has to be injected into the affected eye by a specialized healthcare provider. Your treatment will most likely start with a schedule of monthly injections for several months and then decrease to every other month injections. 

The conditions that are treated with Eylea involve eye damage caused by leaking blood vessels of the eye. Eylea is a vascular endothelial growth factor (VEGF) inhibitor that works by inhibiting excessive growth of blood vessels, which helps prevent them from leaking. Aflibercept is not available in generic formulation.

Uses 

Eylea is approved by the U.S. Food and Drug Administration (FDA) for the treatment of certain conditions that affect the macula of the eye. The macula is the central part of the retina. The retina is a thin area in the back of the eye that receives visual input, such as light.

Any pressure, blood, or fluid in or near the retina or macula can impair vision and may permanently damage these structures.

Conditions treated by Eylea include:

Neovascular (wet) AMD: This disease causes sudden or slowly progressive loss of vision or blurred vision. It occurs when abnormal blood vessels grow and leak behind the macula of the eye. Risk factors include advanced age, smoking, cardiovascular disease, and a history of dry macular degeneration (progressive degeneration of the macula).

Macular edema following retinal vein occlusion (RVO): This problem might not cause symptoms or it can manifest with blurred vision or vision loss. It is a buildup of fluid in the eye that can occur after a blockage within a retinal vein (a blood vessel in the eye).

Diabetic retinopathy and diabetic macular edema: These disorders can cause vision loss, especially in your central field of vision. Diabetes causes damage to blood vessels throughout the body, including blood vessels in the eye (retinopathy). DR can lead to fluid or blood leaking into the visually important area called the macula.

Before Taking

You should not have this treatment if you have an infection or inflammation in or around your eye. If you have had an allergic reaction to aflibercept or similar VEGF inhibitors in the past, you could be at risk of having a severe retinal or choroidal inflammation in your eye which can be vision threatening.

Other VEGF Inhibitors

A similar medication, Zaltrap (ziv-aflibercept) is used for treatment of colorectal cancer.

Other VEGF inhibitors include Lucentis (ranibizumab) and Beovu (brolicuzimab), used to treat wet AMD, and Avastin (bevacizumab), which is used to treat several types of cancer, including colorectal cancer and ovarian cancer.

Dosage

This medication is supplied as a 2 milligrams (mg)/0.05 milliliters (mL) solution in a single-dose single-use prefilled syringe or in a single-dose vial.

It is given by intravitreal (in the eye) injection with a 30-gauge x 1/2-inch injection needle. The procedure has to be done under sterile conditions. You will receive local anesthesia and pre-treatment with medication to prevent an infection.

Each sterile prefilled syringe or vial is intended to be used for injection into one eye, not both. According to the manufacturer, a new needle and a new sterile prefilled syringe or vial is needed for the second eye. After injection, any unused product must be discarded. All listed dosages are according to the drug manufacturer.

• Neovascular (wet) age-related macular degeneration: The recommended dose is 2 mg (0.05 mL) every four weeks for the first three months, followed by 2 mg (0.05 mL) every eight weeks. It can be administered as frequently as every four weeks and has shown efficacy with one dose every 12 weeks after one year of effective therapy
• Macular edema following retinal vein occlusion: The recommended dose is 2 mg (0.05 mL) administered by intravitreal injection once every four weeks.
• Diabetic macular edema and diabetic retinopathy: The recommended dose is 2 mg (0.05 mL) every four weeks for the first five months, followed by 2 mg (0.05 mL) every eight weeks. It can be administered as frequently as every four weeks.

Your healthcare provider will regularly re-assess your eyes to see how well you are responding and whether you need any adjustments or modifications to your treatment.

Modifications

According to the manufacturer, some people with wet AMD, DME, or DR may need to continue monthly injections rather than the less frequent dosing schedule, even after the initial monthly phase is complete.

Although not as effective as the recommended every 8-week dosing regimen, some patients with wet AMD are treated with one dose every 12 weeks after one year of effective therapy.

How to Take and Store

Eylea should be refrigerated at a temperature of 2 C to 8 C (36 F to 46 F) in its original container and away from light. It should not be frozen.

The medication should not be used past the date stamped on the carton and container label. 

If the medication appears to have particulates or is cloudy or discolored, it shouldn’t be used.

Side Effects

You can experience side effects from the medication. Side effects may require medical and/or surgical attention. Be sure to talk to your practitioner promptly about any new symptoms and to go in for your scheduled follow up visits even if you feel well.

Increased intraocular pressure (an increase in pressure inside the eye) can occur within 60 minutes of intravitreal injection, and in rare instances, it can last for longer. It might not cause symptoms or it can cause hazy or blurred vision. It may be difficult for you to perceive the symptoms so soon after your procedure. Your healthcare provider may monitor you for this side effect.

Common

The most common side effects include:

• Conjunctival hemorrhage (bleeding of the eye)
• Eye pain
• Cataract
• Vitreous floaters (the presence of loose protein in the eye)
• Increased intraocular pressure
• Vitreous detachment (the fluid in the eye separates from the retina)

These side effects can be managed, but it’s important that your healthcare provider is aware if you feel any discomfort or vision changes after your procedure. And your team will also monitor you to check for side effects that might not be causing symptoms for you.

Severe

Some side effects may be especially concerning and could potentially cause damage to your eye if they aren’t treated.

Severe side effects include:

• Endophthalmitis (inflammation in the eye)
• Retinal detachment (separation of the eye from the back of the eye)
• Blood clots

Warnings and Interactions

This medication should be used very cautiously if other medications will be placed in or near the eye.

According to research, it is safe to switch from bevacizumab or ranibizumab to treatment with aflibercept.