Retina Society 2023: Pooled Safety Analysis of Aflibercept 8mg in the CANDELA, PHOTON, and PULSAR Trials

H. Russell Day, MD
Vanderbilt Eye Institute, Nashville, TN

Sunir Garg, MD from the Wills Eye Hospital presented his work on pooled safety data from the aflibercept 8 mg trials. As Dr. Garg explained, four-fold higher molar dose of aflibercept has the potential to suppress VEGF over a longer period of time. Although the safety data in each individual clinical trial were similar between 8 mg and 2 mg aflibercept, pooling the analysis from the CANDELA, PHOTON, and PULSAR trials provides a much larger set of patients to compare the rate of adverse events between the two drug doses.

A total of 1773 patients underwent treatment with 1217 receiving 8 mg and 556 receiving the 2 mg dose. The pooled analysis was carried out over a 48-week follow up period. The rate of adverse events was low and similar between the two treatment groups. Of note, the rate of increased intraocular pressure was 2.3% among both groups. Other adverse events found between the 2 mg and 8 mg aflibercept groups included cataract (2.2% vs 3.0%), conjunctival hemorrhage (2.3% vs 3.0%), vitreous floaters (2.7% vs 3.0%), reduced visual acuity (4.5% vs 2.9%), vitreous detachment (1.6% vs 2.7%), retinal hemorrhage (3.1% vs 2.3%), subretinal fluid (2.2% vs 1.3%), intraocular inflammation (0.5% vs 0.8%), and retinal detachment (0 vs 0.4%). There were no cases of endophthalmitis, vasculitis, or ischemic optic neuropathy in either treatment group.

The study also investigated rates of non-ocular adverse events such as hypertension, COVID-19 and nasopharyngitis, which were all similar between the two groups and likely non-related to the study drug. The rate of APTC including non-fatal stroke, non-fatal myocardial infarction, and vascular death were also low and similar between the doses of drug.

Overall, Dr. Garg concluded that aflibercept 8 mg had comparable safety results when compared to aflibercept 2 mg.