Results of the first practical application Brolucizumab for the treatment of neovascular age-related macular degeneration

Abstract

Introduction. Today the standard of treatment neovascular age-related macular degeneration is frequent intravitreal injections of antibodies to vascular endothelial growth factor. Brolucizumab is one of these medicines, which is a single-chain humanized antibody variable fragment with a very small molecular weight (26 kDa). In our country, there are quite a few publications about the results of using Brolucizumab in the Russian Federation due to the fact that this drug began to be used recently (since mid-2021).Purpose: to evaluate our own experience with Brolucizumab treatment of neovascular age-related macular degeneration (nAMD).Materials and methods. The study included 25 patients with nAMD for the period from September 2021 to June 2022, among them 17 women, 8 men, the average age of the patients was 77.07 ± 4.88 years. All patients were divided into 2 groups. The first group included 15 patients previously treated with Ranibizumab. The second group included 10 patients who had not previously received anti-angiogenic therapy. All patients underwent an average of 2 or more IVIs of Brolucizumab and a standard ophthalmological examination, as well as optical coherence tomography (OCT) at the first checkup and one month after each IVI with using the Nidek RS-3000 Advance Angioscan device (Nidek, Japan). All patients included in this study signed an informed consent for it.Results. Almost all patients during the anti-angiogenic therapy with Brolucizumab showed an improvement in anatomical and functional parameters. In the first group the average visual acuity at the time of data analysis increased by 12.7% compared to the baseline, while in the second group - by 57%. The average thickness of the central retina zone in patients of the first group decreased by 13.8% compared to the initial one, while in the second group by 50.9%. During the study period, one case of an adverse event in the form of moderate vitreitis was registered, which occurred on the 8th day after the fourth IVI of Brolucizumab, previously the patient received two IVIs of Ranibizumab. At the time of data analysis, the patient continued to receive anti-inflammatory therapy with positive dynamics in terms of stopping the symptoms of vitreitis.Conclusion. This study showed the high efficacy of Brolucizumab in the treatment of nAMD, which was manifested by an improvement in anatomical and functional parameters in patients of both groups. However, the treatment efficacy was higher in patients without previous antiangiogenic therapy. The resulting case of side effect in the form of intraocular inflammation requires a deeper analysis in order to correctly select patients for IVI in the future.