NEW TRIAL analysis suggests that patients with vasculopathy affecting the retina achieve similar vision outcomes with less frequent injections, potentially easing treatment burden while maintaining safety and effectiveness.
Understanding Vasculopathy in Retinal Disease
Polypoidal choroidal vasculopathy is a subtype of neovascular age related macular degeneration characterised by abnormal blood vessel networks beneath the retina. This form of vasculopathy is a major cause of vision loss, particularly in older adults, and often requires long term anti vascular endothelial growth factor therapy. Standard treatment typically involves frequent intravitreal injections, creating a substantial burden for patients and services. Identifying dosing strategies that maintain visual outcomes while reducing visit frequency is therefore a key clinical priority in managing vasculopathy.
Trial Evidence on Vasculopathy and Aflibercept Dosing
Researchers conducted a post hoc subgroup analysis of the phase 3 PULSAR randomised clinical trial, focusing on 139 participants with indocyanine green angiography confirmed polypoidal choroidal vasculopathy. Participants were randomly assigned to aflibercept 8 mg every 12 weeks, aflibercept 8 mg every 16 weeks, or aflibercept 2 mg every 8 weeks, following three initial monthly doses. Mean baseline best corrected visual acuity scores were 56.3, 60.1, and 57.6 letters, respectively. At week 48, least squares mean changes in visual acuity were +9.5 letters for 8 mg every 12 weeks, +8.4 letters for 8 mg every 16 weeks, and +9.1 letters for 2 mg every 8 weeks. The estimated difference between 8 mg every 12 weeks and 2 mg every 8 weeks was 0.40 letters, with a 95% CI of −4.4 to 5.2. Importantly, 68 of 78 participants, or 87%, receiving aflibercept 8 mg maintained dosing intervals of 12 weeks or longer. Polypoidal lesions were absent at week 48 in 37%, 47%, and 38% of participants across the three groups, indicating comparable anatomic outcomes in this vasculopathy population.
Implications For Clinical Practice in Vasculopathy
These findings support aflibercept 8 mg as an alternative monotherapy for polypoidal choroidal vasculopathy, offering similar visual and anatomic results with fewer injections. For clinicians, this may translate into improved adherence, reduced clinic visits, and lower treatment burden without compromising outcomes. Future studies and real world data will be important to confirm long term safety, durability, and patient reported benefits as vasculopathy management continues to evolve.
Reference
Lee WK et al. Aflibercept 8 mg in polypoidal choroidal vasculopathy: post hoc analysis of the PULSAR randomized clinical trial. JAMA Ophthalmol. 2025;DOI:10.1001/jamaophthalmol.2025.5098.
