Second-Generation Anti-VEGFs Transform Wet AMD Treatment

Anti-VEGF Treatments for AMD: A 10-Point Summary

This article discusses the evolving landscape of anti-VEGF treatments for exudative Age-related Macular Degeneration (AMD), offering guidance on optimal treatment strategies. Here’s a 10-point summary:

1. First-Generation Still Strong: Ranibizumab and aflibercept (2mg) remain excellent first-line treatment options due to their proven efficacy and strong safety profiles.

1. Biosimilars Offer Cost Savings: the availability of biosimilars for first-generation drugs (ranibizumab now, aflibercept expected in 2026) makes them even more attractive as initial treatments.

1. Second-Generation – potent, But Riskier: Newer, second-generation anti-VEGFs (brolucizumab, faricimab, aflibercept 8mg) offer increased potency but carry a higher risk of intraocular inflammation.

1. inflammation Timing Matters: Inflammation with second-generation drugs tends to occur earlier (2-4 injections) than with brolucizumab (6-8 months).

1. Brolucizumab – Reserved Use: Due to its less favorable safety profile, brolucizumab should be reserved for second-line treatment, especially in severe AMD cases.

1. Faricimab & Aflibercept 8mg – Caution with Prior Inflammation: While better tolerated than brolucizumab, faricimab and aflibercept 8mg aren’t recommended as first-line if a patient has a history of inflammation.

1. Switching Strategies: If initial treatment with first-generation drugs isn’t optimal, switching to a second-generation agent can be considered.

1. Inflammation Requires Action: If inflammation does occur with a second-generation drug, switching back to a first-generation agent is generally recommended. Severity of inflammation may influence this decision.

1. Patient Education is Key: Clear interaction with patients about early warning signs of inflammation (pain, redness, blurred vision) and the need for urgent consultation is crucial.

1. Precautionary Principle: Given limited data, a cautious approach is advised, prioritizing better-tolerated molecules and careful monitoring, especially during the induction phase of treatment.