Clinical Ophthalmology (Aug 2022)
Early Canadian Real-World Experience with Brolucizumab in Anti-Vascular Endothelial Growth Factor-Experienced Patients with Neovascular Age-Related Macular Degeneration: A Retrospective Chart Review
Abstract
Michel Giunta,1,2 Louis-Pierre Gauvin Meunier,3 Donald Nixon,4,5 Jeff Steeves,6 Jason Noble7,8 1GOGiunta Ophtalmologie, Sherbrooke, QC, Canada; 2Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada; 3Institut de l’Œil des Laurentides, Boisbriand, QC, Canada; 4Northern Ontario School of Medicine, Barrie, ON, Canada; 5TriMed Eye Centre, Barrie, ON, Canada; 6Department of Ophthalmology and Visual Sciences, Dalhousie University, Rothesay, NB, Canada; 7Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada; 8Sunnybrook Health Sciences Centre, Toronto, ON, CanadaCorrespondence: Michel Giunta, GOGiunta Ophtalmologie, 20, 12e Avenue S., #200, Sherbrooke, Québec, J1G 2V4, Canada, Tel +1 819 563 6889, Email [email protected]: To assess early real-world outcomes with brolucizumab in Canadian patients with neovascular age-related macular degeneration (nAMD) for which they previously received ≥ 1 anti-vascular endothelial growth factor (anti-VEGF) agent(s).Patients and Methods: This multisite, real-world, retrospective chart review included data from a consecutive sample of 73 patients who received brolucizumab for nAMD after treatment with ≥ 1 other anti-VEGF agents. The principal reasons for switching to brolucizumab were to extend the treatment interval (51.6% of patients) and to treat persistent macular fluid (34.2%). The primary outcomes were best-corrected visual acuity (BCVA) and the incidence rates of intraocular inflammation (IOI), retinal vasculitis (RV), and retinal vascular occlusion (RVO). Secondary outcomes included central retinal thickness (CRT), injection interval, and presence of intraretinal and subretinal fluid (IRF and SRF). All parameters were measured at baseline until the last treatment visit between April 27, 2020, and August 31, 2021.Results: Over a mean follow-up of 28 weeks, a nonsignificant mean improvement in BCVA was identified (4.3 [standard deviation (SD) 8.3] letters; P=0.057), with 47.9% experiencing a gain of ≥ 5 letters. IOI was detected in 3 patients (4.1%), one of whom also developed RV and RVO (1.4%), which is consistent with existing brolucizumab data. Significant reductions were observed in mean CRT (− 36.6 μm [SD 56.1 μm]; P=0.0002) and presence of any macular fluid (56.1% [SD 5.6%]; P< 0.001), IRF (66.6% [SD 6.3%]; P< 0.001), and SRF (62.7% [SD 6.3%]; P< 0.001). The mean injection interval increased significantly by 2.1 weeks (SD 2.7; P< 0.001).Conclusion: In the first real-world Canadian analysis, brolucizumab was associated with improvements in functional outcomes in treatment-experienced patients, consistent with other real-world studies. The incidence of IOI, RV, and RVO were in line with the post hoc safety analysis of HAWK and HARRIER data.Keywords: best-corrected visual acuity, central retinal thickness, injection interval, intraocular inflammation, retinal vascular occlusion
