A 68-year-old man with neovascular AMD in the right eye has received monthly intravitreal ranibizumab for 3 months. OCT at month 3 shows persistent subretinal fluid and intraretinal cysts. The treating physician considers switching to a different anti-VEGF agent. Which agent has a higher binding affinity for VEGF-A and also binds VEGF-B and placental growth factor (PlGF)?

• A Ranibizumab
• B Bevacizumab
• C Brolucizumab
• D Aflibercept ✓

Explanation

Aflibercept is a recombinant fusion protein that acts as a VEGF trap, binding VEGF-A, VEGF-B, and placental growth factor (PlGF) with higher affinity than ranibizumab or bevacizumab. Ranibizumab and bevacizumab bind only VEGF-A. Brolucizumab is a single-chain antibody fragment binding VEGF-A only. VIEW trials showed afliberizumab non-inferior to ranibizumab with extended dosing intervals.

Reference: Ryan's Retina, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.