Switching to Brolucizumab in Neovascular Age-Related Macular Degeneration Incompletely Responsive to Ranibizumab or Aflibercept: Real-Life 6 Month Outcomes.

Christof Haensli,Justus G Garweg,Isabel B Pfister

doi:10.3390/jcm10122666

Abstract

Purpose: The aim of this study was to evaluate the effect of switching treatment in eyes with neovascular age-related macular degeneration (nAMD) and treatment intervals of ≤6 weeks to brolucizumab. Methods: In this prospective series, eyes with persisting retinal fluid under aflibercept or ranibizumab every 4–6 weeks were switched to brolucizumab. Visual acuity (BCVA), reading acuity (RA), treatment intervals, central subfield thickness (CST), and the presence of intra- and subretinal fluid were recorded over 6 months. Results: Seven of 12 eyes completed the 6 month follow-up and received 4.4 ± 0.5 brolucizumab injections within 28.0 ± 2.8 weeks. Treatment intervals increased from 5.3 ± 0.9 weeks to 9.0 ± 2.8 weeks (95% confidence interval of extension (CI): 1.6 to 5.9). BCVA improved from 67.8 ± 7.2 to 72.2 ± 7.5 (95% CI: −0.3 to 9.1) ETDRS letters, RA improved from 0.48 ± 0.15 to 0.31 ± 0.17 LogRAD (95% CI: 0.03 to 0.25), and CST improved from 422.1 ± 97.3 to 353.6 ± 100.9 µm (95% CI: −19.9 to 157.1). Treatment was terminated early in five eyes (two intraocular inflammations with vascular occlusion without vision loss, one stroke, and two changes in the treatment plan). Conclusions: Improvement in visual performance and longer treatment intervals in our series over 6 months indicate the potential of brolucizumab to reduce the treatment burden in nAMD, while two instances of intraocular inflammation were encountered.

Highlights

The prevalence of neovascular age-related macular degeneration is increasing, along with an increasing treatment burden for patients and healthcare systems [1]
Disease stability is not achieved in all eyes, with averages of 62.9% and 56.0%, respectively, after 12 and 24 months of treatment, whereas treatment intervals may be extended during the same periods to ≥12 weeks, with stability at 37.7% and 42.6%, respectively [2]
Twelve eyes of 12 patients were switched to brolucizumab according to the abovementioned criteria between February and May 2020 in our center

Summary

Introduction

The prevalence of neovascular age-related macular degeneration (nAMD) is increasing, along with an increasing treatment burden for patients and healthcare systems [1]. (Eylea® , Bayer Pharmaceutical AG, Germany), and brolucizumab since 2020 (Beovu® , Novartis AG, Switzerland) Despite these options, disease stability is not achieved in all eyes, with averages of 62.9% and 56.0%, respectively, after 12 and 24 months of treatment, whereas treatment intervals may be extended during the same periods to ≥12 weeks, with stability at 37.7% and 42.6%, respectively [2]. Recent studies showed a short-term reduction of foveal thickness 4–8 weeks after switching to brolucizumab in eyes with active nAMD despite the consequent anti-VEGF treatment every 4–8 weeks, indicating its superior efficacy regarding anatomic criteria [5,6,7]. Adding to this short-term experience, the aim of this study was to evaluate the functional and anatomic outcomes after switch to brolucizumab over 6 months in eyes with active nAMD under treatment intervals of ≤6 weeks with other anti-VEGF agents

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Discussion

Conclusion