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Aflibercept 8 mg: The Revolution in the Treatment of Retinal Diseases in Latin America
Main Topics and Key Points:
The arrival of aflibercept 8 mg marks a milestone in the treatment of retinal diseases such as age-related macular degeneration (AMD) and diabetic macular edema. Dr. Alejandro Sánchez Oil, a highly experienced retina specialist, shares how this new formulation is impacting the landscape in Mexico and Latin America, offering hope and efficiency in ophthalmology.
Aflibercept 8 mg: A New Leader in Antiangiogenics?
Dr. Sánchez Oil does not believe a single molecule can dominate the anti-angiogenic market, especially in countries like Mexico, where accessibility and cost are key factors. Instead, he considers aflibercept 8 mg 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 lies in extending the treatment interval. This is crucial for diseases that require regular injections, such as neovascular AMD and diabetic macular edema, because it allows injections to be spaced further apart.
Benefits of Fewer Eye Injections:
- Lower risk of complications: Every intraocular injection carries minimal but real 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 can result in a lower total cost of treatment.
- Lower logistical costs: Fewer doctor visits mean lower spending on transportation, travel expenses, and 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 out of use. Both 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).
- Neovascularization due to inflammatory diseases.
- Preoperative use in vitrectomies for proliferative diabetic retinopathy (reduces bleeding).
- Retinopathy of prematurity (requires very small doses).
- Aflibercept 8 mg in Advanced/Severe Disease: In cases of neovascular AMD with high activity, fluid, and in an only eye (where speed is crucial), Dr. Sánchez Oil would consider using 8 mg because it "dries the retina a bit faster." Although studies confirm this faster drying, the decision to start with it is based on severity and the need for a rapid response.
The ideal condition for aflibercept 8 mg is Neovascular Age-Related Macular Degeneration, because of 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" edemas (tractional and non-tractional), a therapeutic trial with an anti-angiogenic 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."
- Without loading: 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 loading: If switching from a different molecule (e.g., ranibizumab, bevacizumab) or if there is treatment failure with 2 mg and a more robust response is sought. The typical loading phase is three monthly injections, although cost is the main limitation.
Economic Aspects and Access in Mexico
The cost per dose of aflibercept 8 mg is higher than that of 2 mg, and the number of doses per vial is lower, which affects the economics for the physician or institution.
Currently, aflibercept 8 mg has not yet formally entered the Mexican public health system (IMSS, ISSSTE), but work is underway on this. Fortunately, private insurers are already covering aflibercept 8 mg if it is approved by Cofepris for the indication (AMD, diabetic macular edema, and in process for vein occlusions). This "levels the market a lot" and makes it easier to adopt the new technology.
Security and Resistance to Adoption
Dr. Sánchez Oil reports excellent safety with intravitreal anti-angiogenic treatment in general, without having experienced serious complications such as retinal detachment or endophthalmitis. The main "resistance" to adopting aflibercept 8 mg lies in the cost for the patient and socioeconomic factors, rather than in medical skepticism.
Advice for New Generations of Ophthalmologists and Retinologists
Dr. Sánchez Oil advises the new generations:
- Stay well informed: Research new treatments thoroughly.
- Stay open: Always look for the best options for patients.
- Collaborate: Discuss cases with colleagues and professors for an enriching learning experience.
Aflibercept 8 mg is a valuable addition to the anti-angiogenic arsenal. Its main benefit is the ability to significantly extend injection intervals, which brings important 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 implementing this new technology correctly and improving patients' lives.
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