June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
A comparison of the therapeutic response between brolucizumab and aflibercept in the HAWK & HARRIER trials using deep learning-based OCT analysis
Author Affiliations & Notes
  • Ursula Schmidt-Erfurth
    Ophthalmology, Medical University of Vienna, Vienna, Austria
  • Zufar Mulyukov
    Novartis, Switzerland
  • Bianca S S. Gerendas
    Ophthalmology, Medical University of Vienna, Vienna, Austria
  • Philippe Margaron
    Novartis, Switzerland
  • Daniel Lorand
    Novartis, Switzerland
  • Hrvoje Bogunovic
    Ophthalmology, Medical University of Vienna, Vienna, Austria
  • Georges Weissgerber
    Novartis, Switzerland
  • Footnotes
    Commercial Relationships   Ursula Schmidt-Erfurth, Boehringer Ingelheim (C), Genentech (C), Heidelberg Engineering (C), Kodiak (C), Novartis (C), Roche (C); Zufar Mulyukov, Novartis (E); Bianca S Gerendas, IDx (F), Novartis (C), Roche (C); Philippe Margaron, Novartis (E); Daniel Lorand, Novartis (E); Hrvoje Bogunovic, None; Georges Weissgerber, Novartis (E)
  • Footnotes
    Support  Christian Doppler Research Association, the Austrian Federeal Ministry for Digital and Economic Affairs and the National Foundatjion for Research, Technology and Development, and Novartis AG
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 1159. doi:
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      Ursula Schmidt-Erfurth, Zufar Mulyukov, Bianca S S. Gerendas, Philippe Margaron, Daniel Lorand, Hrvoje Bogunovic, Georges Weissgerber; A comparison of the therapeutic response between brolucizumab and aflibercept in the HAWK & HARRIER trials using deep learning-based OCT analysis. Invest. Ophthalmol. Vis. Sci. 2020;61(7):1159.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : HAWK and HARRIER are 2-year randomized phase III trials comparing brolucizumab and aflibercept for the treatment of neovascular age-related macular degeneration. A deep learning-based analysis of OCT scans was applied to compare effect size and durability of anti-VEGF agents on macular fluids.

Methods : In HARRIER, 743 patients were randomized to brolucizumab 6mg q12w, with the option of increasing the dosing frequency to q8w, or aflibercept 2mg at a q8w dosing. A previously described deep learning-based algorithm was applied on 19,034 OCT scans acquired monthly to derive volumes (in nl) of intraretinal fluid (IRF), subretinal fluid (SRF) and pigment-epithelial detachment (PED) for the areas around the macular center (1, 3, and 6 mm). The same approach was followed for HAWK.

Results : In HARRIER, baseline mean (SD) IRF volumes (20 (41), 62 (122) and 82 (168) nl in the 1, 3 and 6 mm areas, respectively) decreased by >93% following the first intravitreal injection and consistently remained very low during the entire follow-up with both agents. Baseline mean (SD) SRF volumes (20 (36), 123 (177) and 364 (499) nl in the 1, 3 and 6 mm areas, respectively) decreased by >75% following the first injection with both agents. However, during follow-up, SRF volumes resolved significantly better with brolucizumab while aflibercept left fluctuating amounts of SRF up to 100nl across the 6mm area. Moreover, PED volume resolution to about 50% of its baseline mean (SD) value (69 (92), 337 (452) and 425 (583) nl in the 1, 3 and 6 mm areas, respectively) was consistently more pronounced and stable with brolucizumab. Results from HAWK were analysed in the same manner.

Conclusions : Brolucizumab induced a durable resolution of neovascular fluid as early as after a single injection in all compartments. While superficial fluid (IRF) resolved most rapidly and similarly with both agents, brolucizumab, with a q12w/q8w regimen, was consistently superior in reducing deeper fluid volumes (SRF, PED) associated with neovascular activity.

This is a 2020 ARVO Annual Meeting abstract.

 

Mean IRF, SRF, PED volumes in central 1, 3, 6 mm areas. IRF: sustained decrease following first injection with both agents, SRF/PED: more pronounced and stable resolution with brolucizumab

Mean IRF, SRF, PED volumes in central 1, 3, 6 mm areas. IRF: sustained decrease following first injection with both agents, SRF/PED: more pronounced and stable resolution with brolucizumab

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