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Retina

Study: Brolucizumab use for nAMD poses challenges

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According to a recent study presented at ARVO 2021, intravitreal brolucizumab use (IVB; Beovu, Novartis)  was significant for risks versus intravitreal aflibercept (IVA; Eylea, Regeneron Pharmaceuticals, Inc.) in eyes with prior anti-VEGF. With $883 per event added to the marketed q12W cost, IVB is still cost efficient by $3237 versus an q8W IVA regimen in 1 year.

The researchers reported that lower costs make IVB an attractive alternative for neovascular AMD (nAMD) treatment, however, increased risks compounded by higher individual treatment costs is dramatic compared to IVA. Additional follow-ups with potential irreversible vision loss increase patient burden and warrant extra caution with IVB use. Prospective study >1 year would aid this evaluation, they added.

The retrospective clinical analysis was conducted to evaluate the relative risk of adverse events and adjunctive treatment costs for patients with nAMD in a year-long cohort study to analyze pre-treated anti-VEGF eyes that converted to IVB. The chart review of 144 patients included those who received treatment between 10/1/2019-12/4/2020, and who had IVB initiated between 11/2019-4/2020 and previous anti-VEGF treatment. Random selection of 155 patients treated with IVA for nAMD was used for comparison. The number of follow-ups and healthcare expenditures were used to assess costs. Best-corrected visual acuity (BCVA) was the key outcome safety measure.

Total of 11.1%, or 16 eyes, with IVB had adverse events (uveitis, RAO, and ACI versus 1 uveitis case, or 0.64%, in the IVA group. Eyes that switched to IVB had higher inflammatory rates with relative risk of 17.2 compared to IVA. Mean baseline ETDRS letters was 52.58 vs 45.37 at the last examination with an overall decreased BCVA (-7.20 ETDRS). BCVA ± 2 lines were maintained in 68.8% of patients at the last exam. Total treatment costs were $14,128 to $1,336 in IVA. On average, the adjunct cost was $883 per patient on IVB.

Reference
Sharma K, et al. Cost efficacy and challenges of real-world brolucizumab use for neovascular AMD. Presented at ARVO 2021.

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