UK Guidelines for Aflibercept in Diabetic Macular Edema
Yes, UK guidelines are used for treating diabetic macular edema with aflibercept (Eylea), which is recommended as a first-line anti-VEGF therapy, particularly for patients with visual acuity of 20/50 or worse.
UK Guideline Recommendations for DME Treatment
The International Council of Ophthalmology (ICO) guidelines, which include UK practice standards, provide specific recommendations for diabetic macular edema (DME) treatment based on resource settings 1:
- For center-involving DME with vision loss (6/9 or 20/30 or worse), intravitreal anti-VEGF therapy including aflibercept (Eylea) 2 mg is recommended as first-line treatment
- Aflibercept may provide better visual outcomes over 1 year compared to other anti-VEGF agents, especially in eyes with baseline visual acuity of 6/15 (20/50) or worse
Treatment Protocol for Aflibercept
The standard UK treatment protocol for aflibercept in DME includes:
- Initial loading phase: Three monthly injections of 2 mg aflibercept
- Maintenance phase: 2 mg every 8 weeks, with potential for extended intervals based on clinical response 2
- Alternative protocols include treat-and-extend (gradually increasing interval between injections based on treatment response) and PRN (as needed) based on presence of subretinal or intraretinal fluid
Efficacy Considerations
- For patients with visual acuity of 20/50 or worse, aflibercept has demonstrated superior outcomes compared to bevacizumab and ranibizumab 3
- For patients with better visual acuity (20/40 or better), all three anti-VEGF agents (aflibercept, bevacizumab, ranibizumab) show similar visual outcomes 2
- In real-world studies, aflibercept has shown significant improvements in visual acuity and anatomical outcomes over 36 months of treatment 4
Resource Considerations
In countries with limited resources, UK guidelines acknowledge that:
- Off-label alternatives such as bevacizumab (Avastin) may be considered instead of more expensive drugs like ranibizumab (Lucentis) or aflibercept (Eylea) 1
- In low or intermediate resource settings, focal or grid laser treatment may be considered as primary treatment for DME
Monitoring and Follow-up
According to UK practice standards:
- Patients should be followed every 4 weeks during the loading phase
- During maintenance phase, follow-up can align with the injection schedule (typically every 8 weeks)
- Follow-up can be extended if stability is maintained over 3 consecutive visits 2
Special Considerations
- For patients with DME who have an unsatisfactory response to other anti-VEGF agents, switching to aflibercept has shown acceptable short-term visual and anatomical improvements 5
- Blood pressure should be monitored as systemic absorption of anti-VEGF agents may potentially affect blood pressure in some patients 6
UK guidelines emphasize the importance of optimizing medical treatment (glycemic control, hypertension management, and lipid control) alongside ophthalmic interventions for all patients with diabetic retinopathy and DME 1.