The Effectiveness of Brolucizumab and Aflibercept in Patients with Neovascular Age-Related Macular Degeneration

Abstract

Age-related macular degeneration (AMD) is a progressive, chronic disease of the central area of the retina, which, if untreated, leads to blindness. This study aimed to compare the effectiveness of therapy using anti-VEGF drugs, namely brolucizumab and aflibercept, in patients with neovascular AMD (nAMD) during a monitoring period lasting around 20 weeks. The analysis consisted of 40 patients diagnosed with neovascular age-related macular degeneration, with 20 patients receiving aflibercept (Eylea, Bayer) at a dose of 2 mg/50 µL into the vitreous chamber at the following intervals—3 doses, 4 weeks apart, followed by a fourth dose after 8 weeks. The remaining 20 patients received brolucizumab (Beovu, Novartis) at a dose of 6 mg/50 µL, administered in the following schedule—3 initial doses, 4 weeks apart, with the administration of a fourth dose decided for each patient individually by the doctor, depending on disease activity, assessed through imaging tests. To evaluate treatment effectiveness, the following measurements were used: ‘read distance and near visual acuity’ for each eye separately using the Snellen chart; and non-invasive retinal imaging techniques—optical coherence tomography (OCT) and OCT angiography (OCTA). In patients treated using brolucizumab, during the observation period, statistically significant differences were found in the following parameters: flow area (p = 0.0277); select area (p = 0.0277); FOVEA (p = 0.0073); visus (p = 0.0064). In brolucizumab-treated patients, changes in OCT and OCTA, indicating an improvement, were already visible after the first injection of the drug, whereas in the aflibercept-treated group, changes were only visible after the fourth injection. We found a higher effectiveness of brolucizumab therapy compared to aflibercept in patients with nAMD during an observations period lasting 20 weeks. Our observations are significant, although they require further research.

Efficacy and safety of brolucizumab versus aflibercept in patients with neovascular age-related macular degeneration: a randomized trial in Indian patients

“…This benefit was also maintained at weeks 44 and 48. These results corroborate previous studies [ 15 , 17 , 19 , 20 ]. The SHRM resolution was comparable for both brolucizumab and aflibercept treated eyes.…”

“…The HAWK and HARRIER phase 3 trials have shown the non-inferiority of brolucizumab against aflibercept, with more than 50% of patients with nAMD maintaining the BCVA gains on q12w dosing interval throughout the study period of 48-96 weeks [14,15]. In addition, brolucizumab has shown effectiveness in improving visual acuity in several studies [13][14][15][16][17][18][19][20]. However, the treatment for nAMD may respond differently in patients at different stages of the disease [21] as well as the treatment may differ in patients with diverse ethnicity and genetic make-up [4,22,23].…”

Intravitreal Brolucizumab for Neovascular Age-Related Macular Degeneration in a Vitrectomized Eye

“…Although clinical trials and real-life studies [ 9 , 10 , 11 , 12 ] have reported the efficacy of brolucizumab in nAMD management, response to the treatment in vitrectomized eyes remains to be explored. Barchichat et al [ 13 ] described a case of very severe adverse event after bilateral same-day brolucizumab injections, with progression to blindness.…”

Full-length recombinant antibodies from Escherichia coli : production, characterization, effector function (Fc) engineering, and clinical evaluation

“…Brolucizumab (Beovu®), developed by Novartis, is a humanized single-chain variable fragment (scFv) that acts as a VEGF inhibitor. Approved by the US FDA in 2019 to treat neovascular wet AMD, 57 brolucizumab is produced in E. coli cytoplasm as IBs. Developed by Immunocore, tebentafusp (Kimmtrak®) is a bispecific gp100 peptide-human leukocyte antigen (HLA)-directed T cell receptor fusion with the scFv of an anti-CD3 antibody to redirect T cells to tumor cells that was approved by the US FDA in 2022 for the treatment of metastatic uveal melanoma.…”