Brolucizumab treatment associated with visual acuity improvement for neovascular age-related macular degeneration
Brolucizumab is a low molecular weight humanized antibody fragment as a vascular endothelial growth factor (VEGF) inhibitor. Registered Phase III clinical trials HAWK and HARRIER showed brolucizumab was associated with gains in visual acuity (VA) that were statistically noninferior to aflibercept for treatment-naïve patients with active choroidal neovascularization secondary to neovascular age related macular degeneration (nvAMD). Brolucizumab received FDA approval on October 8th, 2019 for the treatment of nvAMD in the US. The recommended dosage regimen is 6 mg/0.05 mL via intravitreal injection (IVI) monthly for the first 3 doses, then once every 8–12 weeks.
With growing uncertainty concerning the safety and efficacy of brolucizumab relative to other anti-VEGF agents, authors Nicholas J Saba and Scott D Walter set out to retrospectively analyze practice’s initial post-marketing experience with brolucizumab during the first 8 months following FDA approval of the drug on October 7, 2019. Unlike the clinical trial population which enrolled only treatment-naïve eyes with nvAMD, this study population was mostly comprised of eyes switched from another anti VEGF therapy (563/626 eyes, 89.9%). Typically, these patients were switched to brolucizumab for persistent fluid, or with the hope of achieving a longer treatment interval. As such, this was a nonrandom and highly selected population of NVAMD patients. However, authors felt that this population was probably more representative of the nvAMD patients currently being treated with brolucizumab in the United States. Study research questions included whether switching to brolucizumab was associated with changes in VA, improvement in anatomic outcomes, or increases in treatment interval; and whether the observed incidence of adverse events following IVI of brolucizumab was similar to the SRC analysis of the HAWK and HARRIER trials.
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