Abstract
Purpose :
Analyze response to initial brolucizumab injection in patients with nAMD who have failed trials with alternative market anti-VEGF agents.
Methods :
This was a retrospective, observational study of patients that received an initial brolucizumab injection for nAMD after previously receiving three or more injections with bevacizumab, ranibizumab, and/or aflibercept without resolution of fluid on optical coherence tomography (OCT). Change in best corrected visual acuity and OCT biomarkers were analyzed. Specific inclusion criteria consist of a previous diagnosis of nAMD, history of at least three prior anti- Vascular Endothelial Growth Factor (VEGF) injections with aflibercept, ranibizumab, and/or bevacizumab, fluid on pre-injection OCT, age >60, no prior brolucizumab injections in the studied eye, and a follow up visit within 2 weeks – 4 months after injection with brolucizumab. Exclusion criteria consisted of additional retinal pathology, loss to follow up (defined as first follow up appointment five or more months after injection of brolucizumab), OCT not centered near the fovea, and OCT without identifiable landmarks.
Results :
One hundred and forty-eight eyes were included in this study, in which 132 eyes were included in OCT change analysis. There was resolution of intraretinal fluid in 28 out of 47 eyes (p = <0.0001), resolution of subretinal fluid in 56 out of 70 eyes (p = <0.0001), and resolution of sub-retinal pigment epithelium fluid in 8 out of 39 eyes (p = 0.2664). The average change in foveal center point (FCP) from baseline to follow up was -35.46 µm (p = <0.0001; 95% CI -46.40 to -24.51). Best corrected visual acuity (BCVA) in logMAR was 0.57 (Snellen 20/74) at baseline and 0.59 (Snellen 20/78) at follow-up, with an average change of 0.02 (p = 0.202; 95% CI -0.01 – 0.06). There were 3 patients (2.0%) with idiopathic intraocular inflammation, all of which resolved with topical medications and discontinuation of brolucizumab.
Conclusions :
Intravitreal brolucizumab led to resolution of intraretinal and subretinal fluid in a significant number of patients with nAMD who were previously unresponsive to anti-VEGF therapy. Long-term studies are needed to determine the clinical significance of this improvement, as there was not a significant improvement in BCVA after one injection.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.