Six-month Outcomes of Brolucizumab in Routine Clinical Practice: Data from the Fight Retinal Blindness! Registry

Abstract

Purpose : Pivotal trials for neovascular age-related macular degeneration (nAMD) reported that most brolucizumab treated eyes could be extended to a 12-weekly injection interval, with greater central sub field thickness reductions than aflibercept-treated eyes. This retrospective analysis of Australian and Italian data from the prospectively designed observational Fight Retinal Blindness! registry reports outcomes of nAMD eyes switched to brolucizumab in routine clinical practice.

Methods : Eyes receiving vascular endothelial growth factor (VEGF) inhibitors for nAMD that switched to brolucizumab with at least 6 months of follow-up were included. Outcomes of patients with at least two injections of brolucizumab were analysed. We also included patients with only one injection of brolucizumab for the analysis of adverse events. Disease activity, visual acuity (VA), duration between injections and safety were analysed. Analysed data were 100% complete and within pre-specified ranges. The primary outcome measure was the activity of the lesion after switching to brolucizumab.

Results : We identified 84 eyes that switched to brolucizumab and had at least 6 months of follow-up after the first brolucizumab injection, of which 72 had received at least two injections of brolucizumab and were eligible for the analysis of outcomes. Disease quiescence was achieved in nearly half of the 72 participants (from 4% to 44%; P < 0.001). There was a small improvement in mean (95% CI) VA of 3.2 (1.1, 5.3) letters (P = 0.004). Treatment intervals were extended slightly from a median of 48 days at baseline to 59 days at 6 months (P < 0.001). There were 12.5% of eyes that switched back to aflibercept or ranibizumab at 6 months. There were six cases of adverse events recorded in eyes receiving at least one injection of brolucizumab, including two cases of occlusive vasculitis.

Conclusions : Switching to brolucizumab resulted in a significant and substantial reduction in the proportion of lesions that were active on treatment. Most eyes on intensive (median six weekly) treatment were able to be extended to eight weeks or greater. These findings suggest brolucizumab can be considered for eyes on maximal therapy with other VEGF inhibitors, where the benefit of longer treatment interval outweighs the increased risk of intraocular inflammation

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.