Brolucizumab use in a tertiary hospital setting for neovascular age-related macular degeneration (nAMD)

Author: Cristina Cristian (United Kingdom)

Co-authors: Aditi Mohla, Martin McKibbin, Rajarshi Mukherjee

Purpose

Brolucizumab is an anti-Vascular Endothelial Growth Factor (anti-VEGF) recently approved in the UK for the treatment of nAMD. HAWK and HARRIER trials have suggested that following the loading phase, Brolucizumab 8 or 12-weekly administration is non-inferior to Aflibercept, administered every 8 weeks. BREW study showed that Brolucizumab was safe and effective in stabilizing Best-corrected visual acuity (BCVA) in patients who have undergone previous treatment with other anti-VEGFs agents. The potential for 12-weekly dosing is expected to help reduce the number of patient visits and injections. This is particularly important during the recovery phase of the COVID19 pandemic when capacity is limited by the need to maintain social distancing. To assess the efficacy and the risk profile of Broucizumab intravitreal injections (IVT) in patients with an inadequate prior response to Aflibercept. This was defined as persistent disease activity / unstable visual acuity despite frequent therapy or disease control but a heavy treatment burden. A preliminary protocol has been published here: http://yorkshireretinasociety.com/pdfs/yobro%20suggested%20pathway.pdf.

Setting/Venue

Outpatient Consultant-led Medical Retina clinics, in a tertiary hospital setting within Leeds Teaching Hospitals NHS Trust.

Methods

In this retrospective observational study, medical charts of 35 patients with nAMD treated with Brolucizumab IVT between April 2020 to April 2021 were reviewed. Each patient underwent BCVA measured on EDTRS letter chart, central retinal thickness with spectral-domain optical coherence tomography and intraocular pressure measurement, and complete ophthalmic examination at baseline and the last follow-up after Brolucizumab injection.

Results

35 patients had 102 IVT’s of Brolucizumab. The age range was 66 -93 years (Median 80 years) of whom 51% were females. The number of prior Aflibercept injections ranged between 3-62 (Median 17). Their median injection interval when on Aflibercept was 6 weeks (Range 4-10). The first review interval after switching to Brolucizumab was the same as the last interval on Aflibercept. 28 (80%) of the patients had their first follow-up. Median VA was 57 EDTRS letters before and 67.5 after. The median CRT was 337 microns before and 436 after. The treatment was well tolerated by patients and no adverse events were observed.

Conlusions

The median improvement of VA after the first injections was 10.5 letters despite the median CRT increasing by 112.5 microns after the first dose of Brolucizumab. The treatment was well tolerated by the patients and no adverse events were observed, especially there was no intraocular inflammation or vascular retinitis detected in this case series. This case series has limitations, as it is a retrospective data collection predominantly of the first follow-up and therefore long-term results cannot be determined.