Author: Christof Hänsli (Switzerland)
Co-authors: Isabel Pfister, Justus Garweg
Purpose
To evaluate the effect of switching treatment to brolucizumab with regard to morphological and functional outcomes in eyes with neovascular age-related macular degeneration (nAMD) and treatment intervals of ≤six weeks due to high treatment demand under ranibizumab and aflibercept.
Setting/Venue
In this ongoing prospective single-center cohort study eyes with persisting retinal fluid indicating active nAMD under aflibercept or ranibizumab, not exceeding treatment intervals of six weeks in a treat-and-extend (T&E) protocol were switched to brolucizumab.
Methods
Treatment intervals were adjusted according to optical coherence tomography (OCT) imaging and T&E standard of care. Best corrected visual acuity (BCVA), reading acuity treatment intervals, central subfield thickness (CST) and the presence of intra- and subretinal fluid were recorded. We report preliminary 6-months outcomes.
Results
Seven of twelve eyes completed the 6-month follow-up and received 4.3±0.8 brolucizumab injections within 28±2.8 weeks. The treatment interval increased from 5.3±0.9 weeks to 9.0±2.8 (95% confidence interval (CI) -5.9 to -1.6) weeks. BCVA improved from 67.8±7.2 to 72.2±7.5 (95% CI -0.3 to 9.1) ETDRS letters, RA from 0.48±0.15 to 0.31±0.17 LogRAD (95% CI 0.03 to 0.25) and CST from 422.1±97.3 to 353.6±100.9 (95% CI -19.9 to 157.1) µm. Treatment was early terminated in five eyes (45%: twice (18%) for intraocular inflammation and vascular occlusion without vision loss, once (9%) due to transitory ischemic attack, twice (18%) changes in treatment.
Conlusions
Our preliminary 6-month data show improvement in RA and longer treatment intervals after switching to brolucizumab in eyes with incomplete response despite intensive treatment with other anti-VEGF our series. Brolucizumab may thus reduce treatment burden for patients with nAMD, but should be used prudently, with a high degree of awareness and patient education to avoid delayed detection and treatment of possible side effects.
Financial Disclosure
Conflicts of Interest: The authors declare no conflicts of interest. (Commercial relationships dis-closures: Isabelle B. Pfister, None; Justus G. Garweg, AbbVie, Allergan, Chengdu Khanghong, Bayer, Novartis, all without connectionto this work).
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