Comparative Efficacy of Brolucizumab in the Treatment of Neovascular Age-Related Macular Degeneration: A Systematic Literature Review and Network Meta-Analysis

Abstract

Introduction A systematic literature review (SLR) and network meta-analysis (NMA) were conducted to evaluate the comparative efficacy of brolucizumab relative to other anti-vascular endothelial growth factor (VEGF) treatments for neovascular age-related macular degeneration (nAMD) at 1 and 2 years, and overall safety and injection frequency of each treatment. Methods An SLR identifying randomized controlled trials (RCTs) published before June 2021 according to a pre-specified protocol was followed by a Bayesian NMA to compare brolucizumab (6 mg q12w/q8w) against sham and all relevant anti-VEGF regimens. Pooled mean injection frequency, serious adverse ocular events, and discontinuation rates were estimated for each treatment regimen. Results Nineteen RCTs were included in NMA base-case analysis. Brolucizumab (6 mg q12w/q8w) with loading-phase (LP) demonstrated superior best-corrected visual acuity (BCVA) gains to sham both at year 1 (mean difference 16.8 [95%CrI 13.3, 20.4]) and year 2 (mean difference 21.2 [95%CrI 17.4, 25.0]) and was comparable to other anti-VEGFs. Brolucizumab (6 mg q12w/q8w) also showed superior retinal thickness reduction to most comparators including ranibizumab (0.5 mg q4w; year 1 mean difference − 50.1 [95%CrI − 70.3, − 29.8]; year 2 mean difference − 49.5 [95%CrI − 70.8, − 28.6]), aflibercept (2 mg q8w; year 1 mean difference − 39.7 [95%CrI − 52.9, − 26.4]; year 2 mean difference − 35.0 [95%CrI − 49.1, − 21.4]), and faricimab (6 mg q16w/q8w; year 1 mean difference − 27.6 [95%CrI − 42.3, − 12.8]). Brolucizumab (6 mg q12w/q8w) showed similar rates of treatment discontinuation and serious and overall adverse events (both years). At year 2, pooled annualized injection frequency was lowest for brolucizumab (6 mg q12w/q8w) and highest for ranibizumab (0.5 mg q4w) at 5.7 and 11.5 injections annually, respectively. Conclusion Among all licensed anti-VEGF treatments, brolucizumab showed superior reduction in retinal thickness and comparable BCVA gains and discontinuation rates, despite having the lowest injection frequency. The current study provides the most up-to-date, robust comparison of treatments for nAMD. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02193-3.

Brolucizumab in Neovascular Age-Related Macular Degeneration – Indian Real-World Experience: The BRAILLE Study – Fifty-Two-Week Outcomes

“…A systematic literature review and network meta-analysis comparing all anti-VEGF agents, including the most recently approved faricimab, concluded that brolucizumab therapy produces superior retinal thickness reduction with comparable visual outcomes across all molecules at years 1 and 2. 18 This was achieved with the fewest number of injections per year (5.7 injections/year). 18 Our PRN-based study also revealed a comparable injection frequency (4.74 ± [0.75]).…”

“… 18 This was achieved with the fewest number of injections per year (5.7 injections/year). 18 Our PRN-based study also revealed a comparable injection frequency (4.74 ± [0.75]). Despite the lower injection frequency in our real-world data, consistent and sustained morphological improvement was observed throughout the 52-week study period.…”

Review on the Safety and Efficacy of Brolucizumab for Neovascular Age-Related Macular Degeneration From Major Studies and Real-World Data

“…Network meta-analyses have indicated that brolucizumab is noninferior to other anti-VEGF agents in functional and structural outcomes 35–37. Furthermore, real-world data from recent studies on people with nAMD and PCV in several countries have corroborated the efficacy shown in the clinical trials.…”

Brolucizumab in Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema: Ophthalmology and Diabetology Treatment Aspects

“…Age-related macular degeneration (AMD), which is non-exudative or ''dry'' in early stages and may convert to exudative or ''wet'' in later stages (neovascular AMD, nAMD), is characterized by progressive loss of central vision that can become severe [3]. Although nAMD was previously one of the leading causes of blindness in the elderly [3], the use of anti-vascular endothelial growth factor (anti-VEGF) in clinical practice has reduced the incidence of nAMD-associated blindness dramatically [4]. Patients with unilateral late-stage AMD (including both nAMD and dry AMD) are at risk of conversion to macular neovascularization (MNV) in their fellow eye, at rates as high as 38% over 3 years [5].…”