Anti-VEGF injections are among the most used drugs in medicine, and biosimilars of ranibizumab and aflibercept promise major cost savings. Expert guidance from the Fédération France Macula sets out how to use them.
The panel concluded that available evidence, including pivotal phase 3 trials and real-world data, supports the clinical equivalence of ranibizumab and aflibercept biosimilars to their reference products for visual outcomes, anatomical efficacy, safety and immunogenicity. Biosimilars are therefore appropriate alternatives in approved indications. Initiation with a biosimilar is reasonable in selected situations, and switching a clinically stable patient from the reference product to a biosimilar can be done under appropriate monitoring. The one caution is repeated switching between multiple products, which is less well studied.
The practical change is to use anti-VEGF biosimilars as a default option to expand access, including switching stable patients, while keeping traceability and avoiding unnecessary back-and-forth switching.
- Expert guidance on anti-VEGF biosimilars for retinal disease.
- Ranibizumab and aflibercept biosimilars are judged clinically equivalent to reference products.
- Biosimilars are appropriate alternatives in approved indications.
- Switching stable patients from reference to biosimilar is supported with monitoring.
- Repeated switching between multiple products should be approached with caution.
Why it matters
It gives prescribers a clear basis to adopt lower-cost biosimilars rather than defaulting to reference products.
Don't overread it
This is expert consensus from a narrative review, and evidence on repeated switching between multiple products remains limited.
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