Real-World Experience Using Intravitreal Brolucizumab Alone or in Combination with Aflibercept in the Management of Neovascular Age-Related Macular Degeneration

Purpose To evaluate real-world experience using intravitreal brolucizumab (IVBr), alone or in combination with aflibercept, in eyes with neovascular age-related macular degeneration (nAMD) treated previously with other inhibitors of VEGF (anti-VEGF). Methods This was a retrospective study of all eyes with nAMD treated with IVBr on a treat-and-extend protocol at a single center. Best-corrected visual acuity (BCVA), optical coherence tomography (OCT) at baseline and final visit, and drug-related adverse events were analyzed. Eyes with recurrent macular fluid on IVBr every 8 weeks were treated with a combination therapy alternating between IVBr and aflibercept every month. Results Among 52 eyes (40 patients) on IVBr, all had been previously treated with other anti-VEGF therapy, with 73% having persistent macular fluid. After a mean follow-up of 46.2±27.4 weeks on IVBr, the mean treatment interval for intravitreal therapy increased to 8.8±2.1 weeks on IVBr from a baseline of 6.1±3.1 weeks (p<0.001). Macular fluid decreased and BCVA was stable/improved in 61.5% of eyes on IVBr. Ten eyes with increased macular fluid on IVBr monotherapy when extended to every 8 weeks were treated with combination therapy alternating between IVBr and aflibercept every 4 weeks. In these eyes, 80% had improved macular fluid on OCT and 70% stable or improved BCVA after a median follow-up of 53 weeks on combination therapy. Mild intraocular inflammation developed in four eyes, all occurring on IVBr monotherapy, and none had associated vision loss. Conclusion In the real world, IVBr used to treat eyes with nAMD previously treated with other anti-VEGF therapies appears to be well tolerated and associated with an improvement in macular fluid, stabilization of BCVA, and/or increase in intravitreal treatment interval. Combination therapy alternating between IVBr and aflibercept monthly appears to be well tolerated and can be considered for eyes with macular fluid on IVBr every 8 weeks.

[1]  P. Kaiser,et al.  Safety Outcomes of Brolucizumab in Neovascular Age-Related Macular Degeneration , 2021, JAMA ophthalmology.

[2]  D. Chakraborty,et al.  Brolucizumab in Neovascular Age-Related Macular Degeneration – Indian Real-World Experience: The BRAILLE Study , 2021, Clinical ophthalmology.

[3]  P. Radice,et al.  OCT Biomarkers in Neovascular Age-Related Macular Degeneration: A Narrative Review , 2021, Journal of ophthalmology.

[4]  F. Holz,et al.  Short-term real-world outcomes following intravitreal brolucizumab for neovascular AMD: SHIFT study , 2021, British Journal of Ophthalmology.

[5]  Ivana K. Kim,et al.  Risk of inflammation, retinal vasculitis and retinal occlusion-related events with brolucizumab: post-hoc review of HAWK and HARRIER. , 2020, Ophthalmology.

[6]  S. Sadda,et al.  Brolucizumab—early real-world experience: BREW study , 2020, Eye.

[7]  J. Pearlman,et al.  Occlusive Retinal Vasculitis Following Intravitreal Brolucizumab , 2020, Journal of vitreoretinal diseases.

[8]  Rishi P. Singh,et al.  HAWK and HARRIER: 96-Week outcomes from the phase 3 trials of brolucizumab for neovascular age-related macular degeneration. , 2020, Ophthalmology.

[9]  R. Gallemore,et al.  Case Series on Initial Responses to Intravitreal Brolucizumab in Patients with Recalcitrant Chronic Wet Age-Related Macular Degeneration , 2020, International medical case reports journal.

[10]  Lejla Vajzovic,et al.  Retinal vasculitis and intraocular inflammation after intravitreal injection of brolucizumab. , 2020, Ophthalmology.

[11]  Atul K. Jain,et al.  Severe vision loss secondary to retinal arteriolar occlusions after multiple intravitreal brolucizumab administrations , 2020, American journal of ophthalmology case reports.

[12]  D. Do,et al.  Retinal arterial occlusive vasculitis following intravitreal brolucizumab administration , 2020, American journal of ophthalmology case reports.

[13]  Gui-Shuang Ying,et al.  Age-Related Macular Degeneration Preferred Practice Pattern®. , 2019, Ophthalmology.

[14]  Sandra M. Brown,et al.  Five-year outcomes of intravitreal drug therapy for neovascular age-related macular degeneration in eyes with baseline vision 20/60 or better , 2019, Clinical ophthalmology.

[15]  U. Schmidt-Erfurth,et al.  HAWK and HARRIER: Phase 3, Multicenter, Randomized, Double-Masked Trials of Brolucizumab for Neovascular Age-Related Macular Degeneration. , 2019, Ophthalmology.

[16]  Glenn J Jaffe,et al.  Five-Year Outcomes with Anti-Vascular Endothelial Growth Factor Treatment of Neovascular Age-Related Macular Degeneration: The Comparison of Age-Related Macular Degeneration Treatments Trials. , 2016, Ophthalmology.

[17]  Glenn J Jaffe,et al.  Intravitreal aflibercept injection for neovascular age-related macular degeneration: ninety-six-week results of the VIEW studies. , 2014, Ophthalmology.

[18]  Kang Zhang,et al.  Seven-year outcomes in ranibizumab-treated patients in ANCHOR, MARINA, and HORIZON: a multicenter cohort study (SEVEN-UP). , 2013, Ophthalmology.

[19]  Mark Michels,et al.  Ranibizumab versus verteporfin photodynamic therapy for neovascular age-related macular degeneration: Two-year results of the ANCHOR study. , 2009, Ophthalmology.