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World J Diabetes. Dec 15, 2013; 4(6): 303-309
Published online Dec 15, 2013. doi: 10.4239/wjd.v4.i6.303
Vascular endothelial growth factor trap-eye (Aflibercept) for the management of diabetic macular edema
Ahmadreza Moradi, Yasir Jamal Sepah, Mohammad Ali Sadiq, Humzah Nasir, Salima Kherani, Raafay Sophie, Diana V Do, Quan Dong Nguyen
Ahmadreza Moradi, Yasir Jamal Sepah, Mohammad Ali Sadiq, Humzah Nasir, Salima Kherani, Raafay Sophie, Diana V Do, Quan Dong Nguyen, Retinal Imaging Research and Reading Center, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
Yasir Jamal Sepah, Mohammad Ali Sadiq, Diana V Do, Quan Dong Nguyen, Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE 68198, United States
Author contributions: All authors contributed equally to this work.
Correspondence to: Quan Dong Nguyen, MD, MSc, Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Emile St, Omaha, NE 68198, United States. quan.nguyen@unmc.edu
Telephone: +1-402-5594276 Fax: +1-402-5595514
Received: December 27, 2012
Revised: May 31, 2013
Accepted: June 18, 2013
Published online: December 15, 2013
Processing time: 200 Days and 5.6 Hours
Abstract

Diabetic retinopathy (DR) is the most common cause of visual loss among working age individuals. Diabetic macular edema (DME) is an important complication of DR that affects around one third of the patients with DR. Several treatments have been approved for DME ranging from blood pressure and glycemic control to photocoagulation and more recently the use of vascular endothelial growth factor (VEGF) antagonists. The index review discusses aflibercept (EYLEA®-Regeneron Pharmaceuticals, Inc., Tarrytown, New York, NY, and Bayer Healthcare Pharmaceuticals, Berlin, Germany) in the context of other VEGF antagonists currently available for the treatment of DME. A systematic search of literature was conducted on PubMed, Scopus, and Google Scholar with no limitation on language or year of publication. Pre-clinical studies of aflibercept have shown a higher affinity of this molecule for vascular endothelial growth factor A (VEGF-A) along with a longer duration of action as compared to other VEGF antagonists. Recent clinical trials have shown visual outcome results for aflibercept to be similarly favorable as compared to other available agents with the added benefit of fewer required injections and less frequent monitoring. Aflibercept presents a potential exciting new addition to the armamentarium of current VEGF antagonists available for the treatment of DME and other retinal vascular diseases. However, further studies are indicated to confirm the role, safety, and efficacy of aflibercept for DME.

Keywords: Diabetic macular edema; Diabetic retinopathy; Anti-vascular endothelial growth factor agents; Vascular endothelial growth factor trap-eye; Aflibercept; EYLEA

Core tip: Several different agents have been approved recently for the treatment of diabetic macular edema (DME). The index article outlines the role of aflibercept, an anti-vascular endothelial growth factor (VEGF) agent, as a potential therapeutic option. Results from DME trials with aflibercept have been favorable and comparable to other anti-VEGF agents. Because of its longer half-life, aflibercept may also decrease the frequency of injections for DME patients. These results could be attributed to the stronger and prolonged binding of aflibercept to the VEGF-A receptor compared to other available antagonists. A better understanding of the effect of this drug in DME is expected once the phase 3 trial results are available.