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

Abstract

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.

Keywords:

• age-related macular degeneration
• aflibercept
• anti-VEGF
• brolucizumab
• intravitreal injection; optical coherence tomography

Abbreviations

nAMD, neovascular age-related macular degeneration; IVBr, intravitreal brolucizumab; FDA, Food and Drug Administration; IOI, intraocular inflammation; RV, retinal vasculitis; RVO, retinal vascular occlusion; OCT, optical coherence tomography; BCVA, best-corrected visual acuity; CST, central subfield thickness; IRF, intraretinal fluid; SRF, subretinal fluid.

Acknowledgment

This work was supported in part by the Barbara A and Alan M Roth MD Endowed Chair in Visual Science from the University of California Davis (SSP). There was no other funding support.

Disclosure

Dr Glenn Yiu reports personal fees from AbbVie, Adverum, Alimera, Bausch & Lomb, Clearside, Endogena, Genentech, Gyroscope, Intergalactic, Iridex, Janssen, Myro, NGM Biopharmaceutical, Novartis, Regeneron, Thea, Topcon, and Zeiss, outside the submitted work. Professor Dr Susanna S Park reports grants from Roche/Novartis and Ophthea outside the submitted work. The authors report no other conflicts of interest directly related to this work.