Ziv-aflibercept may provide another anti-VEGF treatment option
Anti-VEGF therapy has become one of the most common treatments in the field of retinal diseases. Indications for anti-VEGF therapy are expanding every day, ranging from FDA-approved indications such as diabetic macular edema, macular edema secondary to central retinal vein occlusion and wet age-related macular degeneration to non-FDA-approved indications such as Coats’ disease, retinopathy of prematurity and non-AMD choroidal neovascularization.
The biggest burden to the health care system is the cost of this medication and associated expenses, and Avastin (bevacizumab, Genentech) is still more commonly used in practice compared with Lucentis (ranibizumab, Genentech), primarily due to its low cost. According to the 2014 annual Preferences and Trends Survey by the American Society of Retina Specialists, 64.5% of U.S. retina specialists and 41.7% of international retina specialists choose compounded bevacizumab as their primary therapy for neovascular AMD. Switching to a cheaper anti-VEGF agent such as bevacizumab may save almost $29 billion over a 10-year period, according to an analysis by Hutton and colleagues.
Eylea (aflibercept, Regeneron) is a recently approved anti-VEGF therapy for AMD, CRVO and DME. It is a recombinant fusion protein that acts as soluble decoy receptors that bind VEGF and placental growth factor. Aflibercept is gaining popularity for cases that are resistant to other anti-VEGF agents with slightly more benefit in terms of visual gain. Unfortunately, ranibizumab ($1,950 per dose) and aflibercept ($1,850 per dose) are expensive, and the latter is not yet available in many countries, including India.
Zaltrap (ziv-aflibercept, Regeneron) is similar to aflibercept. It was approved by the FDA in August 2012 for the treatment of metastatic colorectal carcinoma that is resistant to or has progressed following an oxaliplatin-containing chemotherapeutic regimen. Although structurally identical to intravitreal aflibercept, ziv-aflibercept has a much higher osmolarity. There are concerns that intravitreal injections of ziv-aflibercept solution may be toxic to the retina or uveal tract…….