Brolucizumab Linked to Retinal Fluid Resolution in Patients with nAMD

Article

New research presented at ARVO 2023 suggests intravitreal brolucizumab led to the resolution of IRF and SRF in a significant number of patients with nAMD previously unresponsive to anti-VEGF therapy.

Justin Shortell, MD | LinkedIn

Justin Shortell, MD

Credit: LinkedIn

Intravitreal brolucizumab was linked to the resolution of both intraretinal fluid (IRF) and subretinal fluid (SRF) in a significant number of patients with neovascular age-related macular degeneration (nAMD), according to new findings.

Patients included in the trial were previously unresponsive to other anti-vascular endothelial growth factor (anti-VEGF) therapies before receiving the injection of brolucizumab.

“Our study demonstrated no significant change in visual acuity but did show a statistically significant decrease in retinal swelling,” wrote the investigative team.

The research was presented at the 2023 Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting in New Orleans, Louisiana. Led by Justin Shortell, MD, MedStar Georgetown University Hospital, the trial specifically analyzed the response to initial brolucizumab injection in patients with nAMD who have failed trials with alternative market anti-VEGF agents.

The retrospective, observational study included patients that received an initial brolucizumab injection for nAMD after previously receiving ≥3 injections with bevacizumab, ranibizumab, and/or aflibercept without resolution of fluid on optical coherence tomography (OCT). Shortell and colleagues analyzed the changes in BCVA and OCT biomarkers.

Moreover, specific inclusion criteria for patients consisted of a prior nAMD diagnosis, history of ≥3 prior anti-VEGF injections with aflibercept, ranibizumab, and/or bevacizumab, fluid of pre-injection OCT, and an age greater than 60 years. Additionally, patients could have no prior brolucizumab injections in the study eye and were required to have a follow-up visit within 2 weeks to 4 months after brolucizumab injection.

Patients were excluded if they had additional retinal pathology, loss to follow-up (defined as first follow-up appointment ≥5 months after brolucizumab injection), as well as OCT not centered near the fovea, and OCT without identifiable landmarks.

A total of 148 eyes were included in the study, of which 132 eyes were included in the OCT change analysis. Upon analysis, investigators found no resolution of IRF in 28 of 47 eyes (P <.0001), resolution of SRF in 56 of 70 eyes (P <.0001), and resolution of sub-retinal pigment epithelium fluid in 8 of 39 eyes (P = .2664).

Data showed the average change in the foveal center point from baseline to follow-up was –35.46 µm (P = <.0001; 95% CI, -46.40 to -24.51). Moreover, the 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 = .202; 95% CI, -0.01 to 0.06).

Shortell and colleagues noted 3 patients (2.0%) with idiopathic intraocular inflammation, all of which was resolved with topical medications and discontinuation of brolucizumab.

“Long-term studies are needed to determine the clinical significance of this improvement, as there was not a significant improvement in best-corrected visual acuity (BCVA) after one injection,” investigators wrote.

References

  1. Shortell J, Hill C, Thomas C, Peck T, Melamud A. Brolucizumab Use in Treatment Resistant Neovascular Age Related Macular Degeneration (nAMD). Presented at the 2023 Association for Research in Vision and Ophthalmology Annual Meeting; April 2023; New Orleans, LA
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