Abstract
Purpose :
To investigate intraocular inflammation (IOI)-related adverse events (AEs) in patients with neovascular age-related macular degeneration (nAMD) who initiated brolucizumab treatment, the timing of the events and the associated visual outcomes.
Methods :
Retrospective, real-world review of patients with nAMD treated with ≥1 brolucizumab injection between 1 October 2019 and 30 November 2021 at one of the Retina Associates of Cleveland, Inc. (RACI) clinics in Ohio, USA. Eyes were defined as treatment-naïve (no anti-vascular endothelial growth factor (VEGF) therapy in the 12 months prior to first brolucizumab) or prior-treated (treated with a different anti-VEGF in the preceding 12 months).
Results :
A total of 482 eyes were included, 22 of which were treatment-naive and 460 were prior-treated. IOI-related ocular AEs occurred in 22/482 (4.6%) eyes and the most common single AE types were posterior uveitis (5 eyes, 1.0%), anterior uveitis (4 eyes, 0.8%), and panuveitis (4 eyes, 0.8%). Another 4 eyes (0.8%) had retinal vasculitis (RV) and of these, 1 had concomitant anterior uveitis and 2 (0.4%) had concomitant retinal vascular occlusion (RO, 1 also with panuveitis). Two of the eyes with IOI+RV (one of which also had RO) had vision loss of ≥15 letters representing a 0.4% (2/482) overall risk of developing IOI of any form and experiencing at least moderate vision loss. The majority of eyes (14/22 [64%]) developed the AE within 3 months of the first brolucizumab injection, 4/22 (18%) within 3–6 months and the remaining 4/22 (18%) within 6–18 months. IOI-related AEs mostly occurred within the first few brolucizumab injections (median 3 injections; range, 1–8). Eyes with IOI-related AEs lost a median (interquartile range) of -6.8 (-19.9–0.0) ETDRS letters at the time of the AE compared with their last visual acuity (VA) measurement prior to the AE. Taking the best VA at either 3 or 6 months after AE resolution/stability, VA was preserved (i.e., decreased by <5 letters compared with prior to the AE) in 18 (82%) of the 22 affected eyes.
Conclusions :
In this real-world study, most IOI-related AEs occurred early after brolucizumab treatment initiation. Although patients should be monitored throughout treatment, the first months of therapy therefore require particularly careful monitoring of these events.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.