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PentaVision

Retinal Physician

Article

36-Week Results From QUASAR

Results showed noninferiority of the 8 mg aflibercept groups compared with the 2 mg groups with a visual acuity gain of around 17 to 18 letters.

Richard P. Gale, BSc, MBChB, FRCP, FRCOphth, MEd, PhDMichael A. Singer, MD
Retinal Physician April 24, 2025

Clinical Scorecard: 36-Week Results From QUASAR

At a Glance

CategoryDetail
ConditionRetinal Vein Occlusion (RVO), including branch RVO (BRVO), hemi RVO, and central RVO (CRVO)
Key MechanismsVEGF suppression via intravitreal aflibercept injections at different dosages
Target PopulationAdults ≥18 years with RVO, best corrected visual acuity 24-73 ETDRS letters, and central retinal thickness >300-320 µm
Care SettingMulticenter, global ophthalmology clinical trial setting

Key Highlights

  • Noninferiority demonstrated between 8 mg and 2 mg aflibercept doses with visual acuity gains of 17-18 letters at 36 weeks
  • Robust and rapid CRT reduction (~370 µm) observed across all dosing groups
  • Approximately 90% of patients on 8 mg dosing maintained at least 8-week intervals, with nearly 70% extended to 12 weeks or more by week 36

Guideline-Based Recommendations

Diagnosis

  • Inclusion criteria: best corrected visual acuity between 24 and 73 ETDRS letters
  • Central retinal thickness >300 µm (Topcon/Cirrus OCT) or >320 µm (Heidelberg OCT)
  • Exclude patients with uncontrolled glaucoma (IOP >25 mmHg), recent intraocular inflammation, or uncontrolled hypertension (>160/95 mmHg)

Management

  • Aflibercept dosing regimens: 2 mg every 4 weeks; 8 mg with 3 initial monthly doses then every 8 weeks; 8 mg with 5 initial monthly doses then every 8 weeks
  • Treat-and-extend regimen allowed based on visual acuity loss <5 letters and CRT <320 µm
  • Dose intervals could be shortened to minimum 4 weeks if visual acuity loss >5 letters or CRT increase >50 µm from reference

Monitoring & Follow-up

  • Regular assessment of best corrected visual acuity and central retinal thickness via OCT
  • Monitor intraocular pressure to detect sustained elevation
  • Observe for signs of intraocular inflammation and retinal vasculitis

Risks

  • No new safety signals identified with high-dose aflibercept
  • Slightly higher injection volume (70 µL vs 50 µL) with 8 mg dose without sustained IOP elevation
  • Low rates of paracentesis (0.7%-1%) and intraocular inflammation, with no occlusive retinal vasculitis events reported

Patient & Prescribing Data

Patients with all forms of RVO, mean age ~65 years, predominantly male and White, ~30% Asian

8 mg aflibercept dosing provides comparable visual acuity improvement to 2 mg with potential for extended dosing intervals, maintaining efficacy and safety through 36 weeks

Clinical Best Practices

  • Use OCT and visual acuity criteria to guide treat-and-extend dosing intervals
  • Carefully monitor intraocular pressure and inflammation during high-dose aflibercept therapy
  • Consider patient-specific factors and disease severity when selecting dosing regimen
  • Await longer-term data (week 64) for further guidance on dosing interval extensions and subgroup analyses

References