Brolucizumab interim treatment yields anatomic improvements

Interim treatment with brolucizumab in eyes with neovascular age-related macular degeneration (nAMD) after a suboptimal response to a fixed aflibercept, ranibizumab, or bevacizumab regimen resulted in anatomic improvements that were maintained for at least 6 months in a majority of eyes after switching back to the original anti-VEGF therapeutic, according to a retrospective analysis presented at the ASRS 2021 Annual Meeting. No corresponding significant changes in visual acuity were observed.

The study included 51 eyes treated with a fixed anti-VEGF regimen for a minimum of 6 months prior to switching to brolucizumab. After receiving 1 or more injections of brolucizumab, all eyes were switched back to the previous anti-VEGF agent due to the presence of, or to avoid the risk of, intraocular inflammation. Eyes were followed for 6 months.

At the first brolucizumab injection (T1), 73% of eyes had persistent subretinal fluid (SRF), 33% of eyes had persistent intraretinal fluid (IRF), and 80% of eyes had a subfoveal pigment epithelial detachment (PED). Eyes received a mean of 1.78 brolucizumab injections. Twenty-two percent of eyes developed intraocular inflammation while receiving brolucizumab. At the final brolucizumab injection (T2), 84% of eyes had decreased SRF, 71% of eyes had decreased IRF, and 29% of eyes had decreased PED height. At the final brolucizumab injection (T3), decreased SRF was sustained in 55% of eyes, decreased IRF was sustained in 67% of eyes, and decreased PED height was sustained in 67% of eyes.

Chronic SRF resolved in 49% by T2 and did not recur in 30% by T3. Chronic IRF resolved in 47% by T2 and did not recur in 29% by T3. Mean visual acuity (VA) at T1, T2, and T3 was 0.396 logMAR (~20/50), 0.441 logMAR (~20/55), and 0.468 logMAR (~20/59), respectively.

Reference
Awh CC. Interim Treatment with Brolucizumab: Risk Without Reward, or a Jump-start to Better Outcomes? Presented at: ASRS 2021 Annual Meeting.