Summary

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• Eylea (aflibercept) is indicated for the treatment of patients with neovascular (wet) age-related macular degeneration (AMD), macular edema following retinal vein occlusion (RVO), diabetic macular edema (DME), diabetic retinopathy (DR), and retinopathy of prematurity (ROP).
• This summary is based on the review of 58 systematic reviews or meta-analyses. ^[1-57]
• Anti-VEGF therapies (aflibercept, ranibizumab, bevacizumab) improved visual acuity (VA) in approximately 30% of Diabetic Macular Edema (DMO) patients, compared to 10% with laser photocoagulation.
• Aflibercept demonstrated superior efficacy in improving best-corrected visual acuity (BCVA) and reducing central retinal thickness (CRT) compared to ranibizumab and bevacizumab, particularly in patients with worse baseline vision.
• In Proliferative Diabetic Retinopathy (PDR), anti-VEGF combined with panretinal photocoagulation (PRP) enhanced visual outcomes and vessel regression while reducing vitreous hemorrhage and vitrectomy needs compared to PRP alone.
• Aflibercept reduced the risk of vision-threatening complications and led to the regression of diabetic retinopathy severity over two years in patients without center-involving DMO.
• Aflibercept, ranibizumab, and bevacizumab demonstrated comparable safety profiles concerning severe systemic adverse events (SSAEs), all-cause mortality, and arterial thromboembolic events.
• Safety estimates were imprecise for less frequent adverse events, including cardiovascular events and death.
• In Proliferative Diabetic Retinopathy (PDR), the combination of anti-VEGF therapy with panretinal photocoagulation (PRP) resulted in similar adverse event profiles compared to PRP alone.
• In Retinopathy of Prematurity (ROP), anti-VEGF treatments were associated with higher retreatment rates but presented fewer complications such as retinal detachment and myopia compared to laser therapy.
• Aflibercept demonstrated superior effectiveness in patients with worse baseline vision in Diabetic Macular Edema (DMO) compared to ranibizumab and bevacizumab, and patients with high-risk Proliferative Diabetic Retinopathy (HRPDR) benefited from anti-VEGF treatments with improved visual acuity and regression of new vessels.
• Better outcomes were consistently observed in treatment-naive patients, and switching to aflibercept from other anti-VEGF treatments showed significant improvements in central retinal thickness (CRT) and functional outcomes in refractory cases.