Real World Efficacy and Safety of Brolucizumab in Neovascular AMD: The REBEL Study

Abstract

Purpose : Brolucizumab was FDA approved for the treatment of neovascular age-related macular degeneration (nAMD) in 2019. This multi-center real-world retrospective study evaluated the safety and efficacy of brolucizumab in patients diagnosed with nAMD.

Methods : In this multi-center retrospective study, both treatment-naïve patients and patients switched to brolucizumab from other anti-VEGF agents were evaluated. Information collected included demographics, number of previous treatments or if treatment naïve, ETDRS visual acuity, central retinal thickness (CRT) and changes in pigment epithelial detachments (PED), if applicable. Improvements in PED height and retinal fluid are evaluated as a proportion of patients. Improvements in visual acuity, CRT and PED height are evaluated as averages. Observed and calculated data is reported.

Results : A total of 282 eyes were evaluated after treatment with brolucizumab for nAMD. The mean [SEM] age of patients was 81.2 [0.51] years. The majority of patients were switched from other anti-VEGF agents after persistent disease activity (63.9%), followed by a desire to elongate treatment intervals (32.3%). Patients received an average of 2.4 [0.06] injections. Over half of the patients treated with brolucizumab discontinued the agent (54.4%), with 86% of these doing so out of caution after reports of intraocular inflammation (IOI) or occlusive vasculitis. A total of 14 patients experienced an adverse event: 10 cases of IOI, one case of occlusive vasculitis and 3 cases of pain. In patients who received at least three treatments of brolucizumab, the proportion of patients with intraretinal fluid (IRF), subretinal fluid (SRF), and PEDs decreased, (34.5% to 27.2%), (49.8% to 31.6%), (59.8% to 54.6%), respectively. Improvements in visual acuity (62.4 [0.94] letters to 64.5 [1.25] letters), CRT (312.4 [6.32] mm to 269.8 [7.31] mm) and PED height (236.0 [15.98] mm to 206.7 [12.9] mm) were also calculated.

Conclusions : Brolucizumab demonstrated efficacy in naïve as well as previously treated patients with nAMD through various measures, by achieving improvements in the proportion of patients without IRF, SRF and PEDs, and improving visual acuity, CRT and PED height. Overall, 10 patients had IOI and one patient had occlusive vasculitis. Further studies are needed to continue evaluating real-world safety and efficacy outcomes of patients treated with brolucizumab.

This is a 2021 ARVO Annual Meeting abstract.