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Aflibercept 8 mg: The Revolution in the Treatment of Retinal Diseases in Latin America
Main Topics and Key Points:
La llegada de aflibercept 8 mg marks a milestone in the treatment of retinal diseases like the age-related macular degeneration (AMD) and the diabetic macular edemaDr. Alejandro Sánchez Oil, a retinologist with extensive experience, shares with us how this new formulation is impacting the landscape in Mexico and Latin America, offering hope and efficiency in the ophthalmology.
Aflibercept 8 mg: A New Leader in Antiangiogenics?
Dr. Sanchez Oil does not believe that a single molecule can dominate the market of antiangiogenics, especially in countries like Mexico, where accessibility and cost are key factors. Instead, consider that aflibercept 8 mg It is a “very useful new tool” that can “make a difference” for many patients.
In the Mexican context, market realities are driving the use of options that aren't always "on-label" or even variants, such as "CBA flipcep," to ensure more patients have access to lifesaving treatments that would otherwise be unaffordable. This need for a "range of affordable options" is a global reality, even in developed countries.
The high initial cost of innovation is understood to be due to investment in research and development, but it is expected to decrease over time, democratizing access to this technology.
Aflibercept 2 mg vs. 8 mg: The Key Is in Interval Extension
Both formulations of aflibercept, 2 mg and 8 mg, work similarly and offer a comparable therapeutic effect. Studies indicate that patients fare "equally well or equally poorly" in terms of clinical response.
The main advantage of aflibercept 8 mg radica en la extension of the treatment intervalThis is crucial for diseases that require regular injections, such as Neovascular AMD and the diabetic macular edema, as it allows injections to be spaced out.
Benefits of Fewer Eye Injections:
- Lower risk of complications: Each intraocular injection It carries minimal but present risks (endophthalmitis, retinal detachment, vitreous hemorrhage, traumatic cataract). Fewer injections mean less exposure to these risks.
- Long-term economic benefit: Although the 8 mg dose may be more expensive initially, fewer injections over one or two years may result in a lower total treatment cost.
- Reduction of logistics costs: Fewer doctor visits mean less expenses for transportation, travel, meals, and less lost income for the patient and their companions.
Dr. Sánchez Oil's Empirical Experience: Promising Results
Based on his personal experience, Dr. Sánchez Oil has observed that with 8 mg of aflibercept, patients "have fared better," noting "faster drying" of the retina and "a slightly different visual improvement." Although he acknowledges that this is an empirical observation, and large-scale clinical studies show a similar effect to 2 mg, his initial results are very encouraging.
Will Aflibercept 8 mg replace the 2 mg dose? No, both will coexist.
Dr. Sánchez Oil is categorical: Aflibercept 2 mg will not fall into disuseBoth presentations will coexist, each with its ideal niche:
- Aflibercept 2 mg: It is sufficient for pathologies that do not require extended regimens or high concentrations, such as:
- Choroidal neovascularization due to high myopia (1-2 injections).
- Neovascularizations due to inflammatory diseases.
- Pre-surgical use in vitrectomies for proliferative diabetic retinopathy (reduces bleeding).
- Retinopathy of prematurity (requires very small doses).
- Aflibercept 8 mg in Advanced/Severe Pathologies: In cases of Neovascular AMD With high activity, fluid, and in only one eye (where speed is crucial), Dr. Sánchez Oil would consider using 8 mg because "it dries the retina a little faster." Although studies confirm this faster drying, the initial decision is based on the severity and the need for a rapid response.
The ideal pathology for aflibercept 8 mg es la Neovascular Age-Related Macular Degeneration due to the possibility of significantly extending treatment intervals.
Management of Limited Response Cases and the "Switch" between Molecules
In cases of diabetic macular edema with a mild epiretinal membrane that did not respond well to 2 mg of aflibercept, Dr. Sánchez Oil has observed complete resolution of the edema by surgically removing the membrane and using an 8 mg intraoperative injection. This suggests a tractional component that may require surgery.
For "mixed" edema (tractional and non-tractional), the therapeutic trial with an antiangiogenic agent is key. If the edema does not resolve, the tractional component is dominant.
As for the "switch" between molecules or doses, it can be done "with or without initial charge."
- No load: If the patient responds well to another dose (e.g. 2 mg) and the goal is only to extend the interval with 8 mg.
- With load: If switching from a different molecule (e.g., ranibizumab, bevacizumab) or if treatment failure occurs at 2 mg and a more robust response is sought. The typical loading is three monthly injections, although cost is the main limitation.
Economic Aspects and Access in Mexico
The cost per dose of aflibercept 8 mg It is greater than the 2 mg, and the number of doses per vial is lower, which impacts the economy for the physician or the institution.
Currently, aflibercept 8 mg has not yet formally entered the Mexican public health system (IMSS, ISSSTE), but work is underway. Fortunately, private insurers They are already covering 8 mg of aflibercept if it's approved by Cofepris for the indication (AMD, diabetic macular edema, and is in the pipeline for venous occlusions). This "flattens the market a lot" and facilitates the adoption of the new technology.
Security and Resistance to Adoption
Dr. Sanchez Oil reports an excellent seguridad with intravitreal antiangiogenic therapy in general, without having experienced serious complications such as retinal detachment or endophthalmitis. The main "resistance" to the adoption of aflibercept 8 mg lies in the cost for the patient/socioeconomic, rather than in medical skepticism.
Advice for New Generations of Ophthalmologists and Retinologists
Dr. Sánchez Oil advises the new generations:
- Get well informed: Thoroughly research new treatments.
- Be open: Always look for the best options for patients.
- Collaborate: Discuss cases with colleagues and professors for enriching learning.
Aflibercept 8 mg is a valuable addition to the arsenal of antiangiogenics. Its main benefit is the ability to significantly extend injection intervals, which brings significant logistical, long-term economic, and safety advantages by reducing the number of procedures. Although it will not replace other molecules, it will coexist with them, each finding its niche in the complex and sensitive Latin American market. Collaboration and information are key to successfully implementing this new technology and improving patients' lives.
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