Daniel Kiernan, MD: Brolucizumab for Treating AMD

With approval for the treatment of wet age-related macular degeneration (wAMD) in early October 2019, the anti-VEGF treatment brolucizumab (Beovu) became the first injection to offer greater fluid resolution than aflibercept on a three-month dosing interval.

With clinical data from the phase 3 HAWK and HARRIER trials supporting its approval, the treatment is one of the first to challenge aflibercept as a preferred first-line treatment for wAMD—however, with the ability to preserve or improve visual acuity in 90% of patients through monthly injections aflibercept has cemented its place in many treatment algorithms.

Still, with HAWK and HARRIER trials both displaying brolucizumab’s ability to induce greater reductions in intraretinal fluid and central subfield thickness as well as non-inferiority to maintain visual acuity compared to brolucizumab, the approval of brolucizumab was met with excitement among retina specialist and ophthalmologists as a whole.

To get the perspective of how a retina specialist interprets and applies the data seen in HAWK and HARRIER trials into real-world algorithms for patients with wAMD, HCPLive® sat down with Daniel Kiernan, MD, vitreoretinal surgeon with Ophthalmic Consultants of Long Island.

HCPLive: Where does brolucizumab fit in current treatment algorithms for age-related macular degeneration?

Kiernan: Great question. And bear in mind that all this has to do with two things. One, the bar is set very high. With monthly anti-VEGF injections, more than 90% of patients have stability or improvement of their vision. That's a really high bar. That's what we've come to expect. Obviously, we want to catch patients early and diagnose them and treat them early because they tend to do better—but how do we get better outcomes?

The other component is how patients are treated by their physicians. Many times we look at biomarkers such as retinal edema, as seen on OCT to determine disease activity. So, if we see fluid on an OCT that equates to active disease, we oftentimes want to treat more frequently.

So, seeing no fluid equates, at least in my mind, to less disease and maybe we can treat less frequently. Brolucizumab had a greater percentage of patients who could be treated every 3 months with a reduction in retinal edema compared to aflibercept in their phase 3 HAWK and HARRIER trial data. So, at least in my hands, I see about 20% of my aflibercept patients who are treated every 2 months or even monthly who still have persistent fluid. Those are the subset of patients that I'm excited to try brolucizumab.