Lone Brolucizumab Linked to Fewer Injections Than Alternating Anti-VEGFs

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A new cohort analysis suggest one-year intravitreal treatment burden can be significantly reduced when patients are only administered brolucizumab.

Alternating brolucizumab (Beovu) with other anti-VEFG agents required patients with neovascular age-related macular degeneration (nAMD) undergo shorter injection intervals than those administered lone, consistent brolucizumab, according to new data from the Association for Research in Vision and Ophthalmology (ARVO) 2022 Meeting.

In new data presented at the annual meeting this week, a team of Cleveland-based investigators observed similar clinical outcomes yet more treatment burden among patients on an alternating anti-VEGF regimen compared to patients administered only brolucizumab for 12 months.

The findings indicate the need for adequate and informed prescribing strategies at baseline for patients with nAMD who generally face burdens with treatment adherence due to the intravitreal administration of anti-VEFG agents.

Led by Jasmyne McCoy of the Retina Associates of Cleveland, the investigators sought to interpret the prolongation of injection intervals, as well as key clinical outcomes including visual acuity (VA) and central macular thickness (CMT) among real-world patients with nAMD treated with either switched brolucizumab and other anti-VEGF agents or just lone brolucizumab.

As they noted, previous HAWK & HARRIER trial data showed treatment-naïve patients with nAMD achieved similar visual gains and improved fluid resolution with brolucizumab versus aflibercept through 48 weeks. The pivotal trial program also assessed differing dosing regimens: 8 or 12 weeks for brolucizumab intravitreal injections—a potentially significant factor in patient adherence.

“Frequent intravitreal injections with anti-VEGF agents constitute an important burden in the management of nAMD, and treatment avoidance by non-adherence puts the patient at risk of avoidable vision loss,” investigators wrote.

The team conducted a retrospective cohort analysis including patients with nAMD who either:

  • Switched to brolucizumab from other anti-VEGF agents, had ≥12 months follow-up and received ≥3 brolucizumab injections and no other anti-VEGF agent in the first 12 months of treatment
  • Switched to brolucizumab from other anti-VEFG agents, had ≥12 months follow-up and ≥2 brolucizumab injections and ≥1 other anti-VEGF agent in the first 12 months of treatment

McCoy and colleagues sought endpoints including change in injection intervals, VA and CMT from baseline to 12 months, as well as a descriptive analysis of anti-VEGF agents used in the alternating treatment group.

The lone brolucizumab cohort included 174 eyes from 154 patients. Mean patient age was 80.5 years old, with 55.8% being female. Mean VA acuity at baseline was 0.48 LogMAR; mean CMT was 305.0 mcm.

The alternating treatment cohort included 47 eyes from 41 patients. Mean patient age was 77.4 years old, with 58.5% being female. Mean VA acuity at baseline was 0.47 LogMAR; mean CMT was 288.6 mcm. Patient eyes received 7.1 brolucizumab injections and 3.2 other anti-VEGF injections in the first 12 months post-switch. The most prevalent non-brolocizumab agents given to patients included aflibercept and bevacizumab (82.7% each), followed by ranibizumab (3.3%).

At baseline, investigators observed nearly 16 fewer days in mean injection intervals for patients receiving alternating anti-VEGF agents versus lone brolucizumab (32.0 vs 47.8). Post-switch, the mean difference extended by another 11.1 days (26.9 vs 48.1).

Patients receiving alternating therapy reported slightly improved VA per LogMAR at 12 months versus patients on lone brolucizumab (-0.03 vs 0.02), while both cohorts reported improved CMT (-34.5 mcm vs -46.2 mcm, respectively).

Just 1.7% eyes in the lone brolucizumab cohort developed inflammatory reactions, while none were reported in the alternating treatment group. Neither retinal vasculitis nor occlusion were reported in any patients.

Investigators concluded both regimens provided maintained VA and reduced CMT over 12 months, while mean injection intervals were nearly two-fold longer among patients on lone brolucizumab.

“Patients treated with only brolucizumab could extend their injection interval twice as much on average as patients alternating treatment with brolucizumab and another anti-VEGF, while preserving vision,” they concluded.

The study, “Characterization of real-world neovascular age-related macular degeneration (nAMD) switch patients treated with brolucizumab alone versus brolucizumab alternating with other anti-vascular endothelial growth factors (anti-VEGF),” was presented at ARVO 2022.