aflibercept: clinical use

Prescribing considerations

• Confirm the intended route and product; ophthalmic pre-filled syringes and the hyperosmotic intravenous concentrate are not interchangeable.
• Record the biological product name and batch number for traceability.
• For intravitreal use, assess ocular infection or inflammation, glaucoma control, recent arterial thromboembolic events and planned intraocular surgery.
• Before intravenous use, control pre-existing hypertension and consider bleeding, thrombotic, cardiovascular, gastrointestinal, renal, wound-healing, surgical and dental risks.

Contraindications and cautions

• Hypersensitivity to aflibercept or a formulation excipient.
• Ophthalmic products: active or suspected ocular or periocular infection, or active severe intraocular inflammation.
• Intravenous concentrate: any ophthalmic or intravitreal administration.
• Apply the separate contraindications of each FOLFIRI component when using intravenous aflibercept.

Monitoring

• Intravitreal treatment: monitor optic-nerve perfusion and intraocular pressure after injection; assess visual and anatomical response and promptly investigate infection, inflammation, retinal tear or detachment symptoms.
• Intravenous treatment: monitor full blood count with platelets, blood pressure, urinary protein, bleeding, thrombosis, infection, diarrhoea and hydration.
• Confirm adequate wound healing around surgery and invasive dental procedures.

Clinical pharmacology

Aflibercept is a recombinant dimeric fusion glycoprotein containing extracellular portions of VEGF receptors 1 and 2 fused to human IgG1 Fc. It sequesters VEGF-A and placental growth factor; the intravenous product additionally describes binding to VEGF-B.

Formulation and product differences

• Afqlir and Vgenfli are single-use ophthalmic pre-filled syringes intended for one eye; each contains excess solution that must be expelled correctly before administration.
• Afqlir uses a glass syringe, while Vgenfli uses a cyclo-olefin polymer syringe; excipients, preparation steps and permitted temporary storage outside refrigeration differ.
• Zaltrap is a hyperosmotic concentrate requiring dilution for intravenous infusion. It must never be given undiluted as a push or injected into the eye.

Solution for infusion

Route: Intravenous

Strengths: 25 mg/mL

Injection

Route: Parenteral

Strengths: 40 mg/mL, 114.3 mg/mL