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Original Investigation
February 25, 2021

Early Experience With Brolucizumab Treatment of Neovascular Age-Related Macular Degeneration

Author Affiliations
  • 1New England Eye Center, Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts
  • 2Retina-Vitreous Associates of Florida, Tampa
  • 3New England Retina Consultants, Springfield, Massachusetts
  • 4Department of Surgery, University of Massachusetts Medical School–Baystate, Springfield
  • 5Harvard University, Cambridge, Massachusetts
JAMA Ophthalmol. 2021;139(4):441-448. doi:10.1001/jamaophthalmol.2020.7085
Key Points

Question  What are the early outcomes associated with brolucizumab injection for neovascular age-related macular degeneration (nAMD)?

Findings  In this case series of 172 eyes evaluated after brolucizumab treatment of nAMD, mean visual acuity (VA) remained unchanged and mean central subfield thickness (CST) decreased. Intraocular inflammation (IOI) observed in 8.1% of eyes was usually mild, often resolving without treatment; potential IOI risk factors included female sex and bilateral same-day brolucizumab treatment.

Meaning  These findings suggest that brolucizumab treatment may be associated with stable VA and reduction in CST in patients with nAMD; further exploration of IOI is warranted to understand its pathogenesis, risk factors, and management.

Abstract

Importance  Outcome data are limited regarding early experience with brolucizumab, the most recently approved anti–vascular endothelial growth factor (VEGF) agent for the treatment of neovascular age-related macular degeneration (nAMD).

Objective  To report clinical outcomes after intravitreous injection (IVI) of brolucizumab, 6 mg, for nAMD.

Design, Setting, and Participants  This retrospective case series conducted at 15 private or academic ophthalmological centers in the United States included all consecutive patients with eyes treated with brolucizumab by 6 retina specialists between October 17, 2019, and April 1, 2020.

Exposures  Treatment with brolucizumab IVI, 6 mg.

Main Outcomes and Measures  Change in mean visual acuity (VA) and optical coherence tomography parameters, including mean central subfield thickness and presence or absence of subretinal and/or intraretinal fluid. Secondary outcomes included ocular and systemic safety.

Results  A total of 172 eyes from 152 patients (87 women [57.2%]; mean [SD] age, 80.0 [8.0] years) were included. Most eyes (166 [96.5%]) were not treatment naive, and 65.7% of these eyes (109 of 166) were switched from the prior anti-VEGF agent because of persistent fluid detected on optical coherence tomography scans. Study eyes received a mean (SD) of 1.46 (0.62) brolucizumab IVIs. The mean (SD) VA prior to starting brolucizumab was a 64.1 (15.9) Early Treatment Diabetic Retinopathy Study (ETDRS) letter score (Snellen equivalent, 20/50) and was a 63.3 (17.2) ETDRS letter score (Snellen equivalent, 20/63) at the last study evaluation (mean difference, 0.8; 95% CI, −2.7 to 4.3; P = .65). When analyzed by number of brolucizumab IVIs, the presence or absence of fluid prior to starting brolucizumab, or the presence or absence of intraocular inflammation after receiving brolucizumab, there was no difference in mean VA prior to starting brolucizumab compared with after brolucizumab IVIs or at the final study evaluation. The mean (SD) central subfield thickness in all eyes prior to starting brolucizumab was 296.7 (88.0) μm and was 269.8 (66.5) μm at the last study examination (mean difference, 26.9 µm; 95% CI, 9.0-44.7 µm; P = .003). Intraocular inflammation was reported in 14 eyes (8.1%) and was self-limited and resolved without treatment in almost half those eyes (n = 6). One previously reported eye (0.6%) had occlusive retinal vasculitis and severe loss of vision.

Conclusions and Relevance  In this analysis of brolucizumab IVI for nAMD, VA remained stable, with a reduction in central subfield thickness. Intraocular inflammation events ranged from mild with spontaneous resolution to severe occlusive retinal vasculitis in 1 eye.

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