Brolucizumab treatment associated with visual acuity improvement for neovascular age-related macular degeneration

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.

Study evaluated the visual and anatomic efficacy of brolucizumab, examined changes in treatment intervals after switching to brolucizumab, and estimated the incidence of drug-related adverse events in the real world. This was a retrospective consecutive case series of 626 eyes (543 patients) with nvAMD treated with 1438 brolucizumab injections at a single retina practice between 10/1/2019 and 5/15/2020. Changes in visual acuity (VA); anatomic outcomes assessed by optical coherence tomography (OCT) including central subfield thickness (CST), macular volume (MV), presence of intraretinal fluid (IRF), subretinal fluid (SRF), and serous pigment epithelial detachment (sPED) on foveal line scans; treatment intervals before and after receiving brolucizumab; and the incidence of brolucizumab-related adverse events.

The majority of eyes (N = 531, 89.7%) had received prior anti-VEGF therapy with aflibercept, ranibizumab, and/or bevacizumab. VA improved in treatment-naïve eyes (+3.7 letters, p = 0.04), and was maintained in previously treated eyes. There were significant improvements in all anatomic outcomes in both groups (p < 0.001). Study observed a 4.8% incidence of intraocular inflammation (IOI) and a 0.6% incidence of retinal vasculitis. The average treatment interval increased from 6.3 to 6.8 weeks (p = 0.001).

“Our real-world experience with brolucizumab largely confirmed the key findings of the HAWK and HARRIER trials. Treatment naïve patients showed significant improvements in vision and anatomy after initiating treatment with brolucizumab. Previously treated eyes maintained VA after switching to brolucizumab, supporting the claim of noninferiority to other anti-VEGF agents. Our analysis found that brolucizumab was highly effective in reducing fluid within all retinal compartments, even in previously treated nvAMD eyes. We found that patients may achieve extended dosing intervals shortly after switching to brolucizumab, especially those with prior treatment intervals.”

Keywords: Beovu, brolucizumab, anti-VEGF, intraocular inflammation, retinal vasculitis

Source: Nicholas J Saba, Scott D Walter; Clinical Ophthalmology 2023:17 2791–2802