One-Year Brolucizumab Outcomes in Neovascular Age-Related Macular Degeneration from a Large United States Cohort in the IRIS® Registry

Abstract

To evaluate real-world visual acuity and injection intervals in patients with neovascular age-related macular degeneration (nAMD) after 12 months of brolucizumab therapy. Retrospective cohort study. Adults in the US-based IRIS® registry (Intelligent Research in Sight) with nAMD who received brolucizumab exclusively for 12 months (2308 eyes; 2079 patients). Observational study of eyes with a first injection of brolucizumab (index), followed by >2 more brolucizumab injections over the following 12 months without switching to another anti-vascular endothelial growth factor (VEGF) agent. Primary outcomes were change in best recorded visual acuity and, for eyes that had received prior anti-VEGF therapy (treatment-experienced eyes), the difference between the injection interval of brolucizumab at 12 months and the pre-switch anti-VEGF injection interval. Pre-switch interval was defined as the time between the prior anti-VEGF and index brolucizumab injections; brolucizumab interval was the time between the closest injection to day 365 and the previous brolucizumab injection. Secondary outcomes included incident adverse events. Overall visual acuity at index was 61.6±18.4 ETDRS letters; 83.7% of treatment-naïve eyes (184/220) and 86.1% of treatment-experienced eyes (1797/2088) showed stable (<10 letters gained/lost) or improved (10+ letters gained) visual acuity at 12 months. Overall, 90.5% of eyes (n=2088) were treatment-experienced. Among treatment-experienced eyes that had received a prior anti-VEGF injection within 365 days pre-index, 29.5% (594/2015) had a pre-switch interval ≥8 weeks (mean, 7.6±5.5 weeks), while 83.1% (1734/2015) had a brolucizumab injection interval at 12 months of ≥8 weeks (mean, 10.3±4.0 weeks). In all, 77.1% (1554/2015) of treatment-experienced eyes had an interval extension of ≥1 week; of these, 55.4% (861/1554) had an extension of ≥4 weeks. In this real-world study, at 12 months, brolucizumab treatment prolonged the interval between anti-VEGF injections for most treatment-experienced eyes, particularly those with a shorter pre-switch interval, while maintaining or improving visual acuity. With careful balancing of the benefits and risks, switching to brolucizumab treatment may offer the advantage of extending the treatment interval for patients with a high anti-VEGF therapy burden.