Real-World Experience with Brolucizumab in Wet Age-Related Macular Degeneration: The REBA Study

Abstract

The aim of the present study was to determine the efficacy and safety of intravitreal brolucizumab therapy for neovascular age-related macular degeneration (AMD) in the real-world setting. The REBA study (real-world experience with brolucizumab in wet AMD) was a retrospective, observational, multicentric study that included 78 consecutive patients (105 eyes), with neovascular AMD, who received brolucizumab therapy. Both treatment-naive and switch-therapy patients were included. Switch therapy was based either on fluid recurrence, fluid recalcitrance, or inability to extend beyond q4/q6. All relevant data were collected. The primary outcome measure was change in best-corrected visual acuity (BCVA) over time. Secondary outcome measures included determination of change in central subfield thickness (CST) and complications. The mean baseline BCVA was 49.4 ± 5.4 letters and 40 ± 3.2 letters, and corresponding mean BCVA gain was +11.9 ± 3.9 letters (p = 0.011) and +10.4 ± 4.8 letters (p = 0.014) in the treatment-naive and switch-therapy groups, respectively. The change in CST was significantly decreased in the treatment-naive (p = 0.021) and the switch-therapy (p = 0.013) groups. The mean follow-up was 10.4 months in both groups. One patient in the switch-therapy group developed vascular occlusion and another a macular hole after the fifth brolucizumab injection. Both patients recovered uneventfully. In conclusion, patients showed a very good anatomical and functional response to brolucizumab therapy in the real world, regardless of prior treatment status, until the end of the follow-up period. Two significant untoward events were noted.

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

“…In comparison, the SRF resolution in the BREW trial was superior (39.4%), while the PED resolution was suboptimal (6.4%). 16 At the same time, the IRF resolution in their eyes (36.8%) was similar to the current study. 16 Intraocular inflammation has been reported with other anti-VEGFs in the past, at an estimated rate of between 0.3% and 2.9% per injection.…”

“…16 At the same time, the IRF resolution in their eyes (36.8%) was similar to the current study. 16 Intraocular inflammation has been reported with other anti-VEGFs in the past, at an estimated rate of between 0.3% and 2.9% per injection. 18,19 The Fight Retinal Blindness!…”

“…In comparison, the SRF resolution in the BREW trial was superior (39.4%), while the PED resolution was suboptimal (6.4%). 16 At the same time, the IRF resolution in their eyes (36.8%) was similar to the current study. 16 …”

“…In contrast, Bilgic et al observed that brolucizumab improved vision in both treatment-naive and switch therapy eyes with nAMD. 16 The "ceiling effect" in patients with very good visual acuity at baseline can also account for the varying visual gains between studies. 17 This can explain the lack of significant visual gain in the treatment-naïve group of our study, who had better mean visual acuity at baseline (0.41[±0.35] LogMAR) as compared to the switch therapy eyes (0.81 [±0.5] LogMAR).…”

Initial Pro Re Nata Brolucizumab for Exudative AMD: The PROBE Study

“…This demonstrates that the chosen treatment interval may not adversely influence the visual gain while fulfilling our anatomical objectives of a dry macula. In addition to our study, other real-life studies have demonstrated the effectiveness of brolucizumab injections in naïve, but also switch patients [17][18][19][20][21]. These data, combined with the present study, reinforce the results of the pivotal randomized controlled trial [11].…”