Aflibercept Dosing Regimen
The standard dosing regimen for aflibercept (VEGF inhibitor) begins with three monthly loading doses followed by maintenance treatment every 8 weeks, with potential for extended intervals based on clinical response and the specific ocular condition being treated.
Condition-Specific Dosing
Age-Related Macular Degeneration (AMD)
- Initial phase: Three monthly injections of aflibercept 2 mg 1
- Maintenance phase: Every 8 weeks (2 mg) 1
- Newer formulation option: Aflibercept 8 mg has demonstrated non-inferior efficacy with extended dosing intervals of every 12-16 weeks after three initial monthly doses 2
Diabetic Macular Edema (DME)
- Initial phase: 4-6 monthly injections of aflibercept 2 mg 3
- Maintenance phase: Every 8 weeks (2 mg) 3
- Treatment modification: Continue until vision and edema are no longer improving 3
- Higher dose option: Aflibercept 8 mg has shown comparable efficacy with extended dosing intervals (every 12-16 weeks) following three initial monthly doses, requiring fewer injections 4, 5
Retinal Vein Occlusion (RVO)
- Initial phase: Monthly injections of aflibercept 2 mg 1
- Maintenance phase: Continue monthly until visual acuity stabilizes 1
- Alternative approach: Treat-and-extend protocol may reduce injection frequency 1
Monitoring and Adjustment
Follow-up Schedule
- Initial follow-up: Every 4 weeks during loading phase 1
- Maintenance follow-up: Aligned with injection schedule (typically every 8 weeks) 1
- Extended intervals: Follow-up can be extended to 8-16 weeks if stability is maintained 3
Treatment Adjustment Criteria
Withhold treatment when:
Resume treatment when:
- Recurrence of fluid on OCT
- Decrease in visual acuity
Treatment Approaches
Protocol Options
- Fixed interval: Monthly or bimonthly injections 1
- Treat-and-extend: Gradually increase interval between injections based on treatment response 1
- PRN (as needed): Treatment based on presence/absence of subretinal or intraretinal fluid 1
Practical Considerations
- Aflibercept 2 mg is administered as an intravitreal injection containing 2 mg in 0.05 mL solution 6
- For center-involved DME with good visual acuity (20/25 or better), observation without treatment may be reasonable unless visual acuity worsens 7
Important Caveats
- Patients should be monitored for signs of endophthalmitis, retinal detachment, or decreased vision following injections 1
- Potential complications include endophthalmitis, noninfectious inflammation, retinal tear, and elevated intraocular pressure 1
- The risk of systemic arterial thromboembolic events with anti-VEGF therapy remains inconclusive in clinical trials 1
- Treatment adherence is critical - real-world studies show that approximately 50% of patients may deviate from intended treatment regimens 8
The optimal dosing regimen should be determined based on the specific ocular condition, disease activity, and patient response to treatment, with the goal of maximizing visual outcomes while minimizing treatment burden.