One-year results of treat-and-extend regimen with intravitreal brolucizumab for treatment-naïve neovascular age-related macular degeneration with type 1 macular neovascularization

Abstract

We evaluated 1-year outcomes of loading phase treatment followed by maintenance treatment using a treat-and-extend (TAE) regimen with intravitreal brolucizumab for neovascular age-related macular degeneration (nAMD) associated with type 1 macular neovascularization (MNV). We analyzed 68 eyes of 65 consecutive patients with treatment-naïve nAMD associated with type 1 MNV. Forty-five eyes (66.2%) completed the 1-year treatment with intravitreal brolucizumab. In those cases, best-corrected visual acuity (BCVA) showed significant improvement, while there were significant reductions in foveal thickness and central choroidal thickness, after the initial brolucizumab injection, which were maintained until the last visit. The average total number of injections over 1 year was 6.4 ± 0.6. The average intended injection interval at the last visit was 14.0 ± 2.9 weeks. Moreover, 17of 23 eyes (73.9%) with polypoidal lesions showed complete regression of these lesions after the loading phase treatment. Although intraocular inflammation (IOI) was observed in 15 of 68 eyes (22.1%) within 1 year, amelioration in response to combination therapy with topical and subtenon injection of steroids, without visual decline, was obtained. These results indicate that loading phase treatment followed by the TAE regimen with intravitreal brolucizumab might improve BCVA and ameliorate exudative changes in eyes with treatment-naïve nAMD associated with type 1 MNV. Moreover, intravitreal brolucizumab can potentially reduce the treatment burden of nAMD. Prompt steroid therapy might be efficacious for ameliorating brolucizumab-related IOI without visual decline.

Switching to brolucizumab: injection intervals and visual, anatomical and safety outcomes at 12 and 18 months in real-world eyes with neovascular age-related macular degeneration

“…Other brolucizumab real-world studies include the REBA study of 105 nAMD eyes with a mean follow-up of 10.4 months [ 21 ], the SHIFT study of 63 eyes that were followed up for four weeks [ 22 ], and two Japanese studies of 68 and 45 eyes, respectively, that were followed up for 1 year [ 13 , 14 ]. Additionally, although the large REALIZE study included 3501 patients that were followed for at least 1 year, only reported on injection interval outcomes and not VA nor CMT [ 23 ].…”

“…Variations in dosing regimens such as treat-and-extend (T&E) have therefore been implemented to balance adequate disease control with fewer anti-VEGF injections over time by extending the injection interval lengths, which reduces the overall injection burden [ 11 , 12 ]. Recent small-scale real-world studies in Japan have reported improved anatomical outcomes, injection intervals of up to 14 weeks, and either maintained or improved VA after switching from other anti-VEGFs to brolucizumab [ 13 , 14 ]. The aim of this real-world study was to investigate VA, injection interval extensions, CMT and safety in nAMD patients who were switched from another anti-VEGF to treatment with brolucizumab only for up to 18 months.…”

The Treatment Patterns with Brolucizumab in Germany (REALIZE) Study: A Retrospective Cohort Study Based on Longitudinal Prescription Data

“…There has been an extensive amount of research in this area which has generated patient management learnings and guidance, to support healthcare professionals in mitigating and managing the risk of inflammatory adverse events and vision loss [27][28][29][30][31][32][33][34][35]. These learnings include patients with a history of previous intraocular inflammation (IOI) being at higher risk, the importance of monitoring for the signs of IOI prior to anti-VEGF injection, educating patients to report any symptoms of IOI as soon as they arise and that prompt intensive treatment of IOI could help prevent or recover vision loss [20,[27][28][29][30][31][32][33][34][35][36][37].…”

Trends in the Cumulative Post-Marketing Reporting Rates of Retinal Vasculitis and/or Retinal Vascular Occlusion and Associated Vision Loss with Brolucizumab

“…Additionally, ophthalmologists recommend that if an IOI-related adverse event occurs, it should be addressed with prompt and intensive treatment as per standard of care [7,[9][10][11][12][13]. Real-world evidence suggests that such treatment can help prevent or recover vision loss [17][18][19][20].…”