Assessment of retinal pigment epithelial detachment treatment response and impact of size on outcomes in neovascular age-related macular degeneration from the OSPREY study

Abstract

Purpose : To evaluate outcomes of eyes with neovascular age-related macular degeneration (nAMD) with moderate to very large retinal pigment epithelial detachments (PEDs) in the OSPREY trial.

Methods : This was a post hoc analysis of the OSPREY phase II, randomized, multicenter, double-masked trial comparing brolucizumab 6mg and aflibercept (AFL) 2mg in nAMD. Treatment-naive nAMD eyes presenting PEDs were evaluated in the following groups as determined at baseline: (1) all PEDs with a maximum height 150µm (brolucizumab n=20, AFL n=21); (2) very large PEDs with a maximum height 250µm (brolucizumab n=12, AFL n=10). SD-OCT scans were analyzed in a machine-learning enhanced novel software platform for multi-layer volumetric assessment to categorize PED size and provide volumetric measures, including sub-RPE volume and intraretinal fluid (IRF) and subretinal fluid (SRF) volumes. No adjustment was made for multiple comparisons.

Results : A total of 41 eyes were included in this analysis. When considering all PEDs 150µm, the mean change in BCVA was +7.3 letters in the brolucizumab group (p=0.02) and +6.6 letters in the AFL group (p=0.05). In the very large PED cohort, mean change in BCVA was +5.6 letters (p=0.26) and -0.4 letters (p=0.94) in the brolucizumab and AFL groups, respectively. In both cohorts, brolucizumab and AFL demonstrated significant reductions in PED maximum height (p<0.05). In very large PEDs, the mean reduction at Week 4 was -122.7µm with brolucizumab compared to -84.1µm with AFL. At Week 56, the mean reduction was -167.0µm with brolucizumab compared to -153.2µm with AFL. Significant reductions in sub-RPE volume were noted with both treatment regimens across all PED cohorts (p<0.05; all but two time points with AFL). In both cohorts at Week 56, there was a reduction in mean IRF volume (0.11 and 0.12mm³ with brolucizumab, 0.08 and 0.10mm³ with AFL) and SRF volume (0.45 and 0.74mm³ with brolucizumab and 0.40 and 0.78mm³ with AFL).

Conclusions : Both brolucizumab and AFL demonstrated significant improvement in PED features. In very large PEDs, functional response was more limited. Although exploratory in nature, this analysis suggests a possibly more rapid improvement in exudative parameters and possibly greater functional response in the very large PED group with brolucizumab.

This is a 2021 ARVO Annual Meeting abstract.