Brolucizumab Effective in Patients With Wet AMD, Regardless of Past Treatment

Long-term stabilizing of retinal exudation and fluid accumulation contributes to brolucizumab’s efficacy in managing wet age-related macular degeneration (AMD). Visual prognosis could be improved when using this treatment, according to a study published in Frontiers in Medicine.1

AMD is a leading cause of blindness worldwide, with its symptoms being irreversible once they progress. AMD affects the macula, which can disrupt distinct vision in the center of the eye but does not usually cause total blindness.2 AMD can be separated into 2 types: neovascular or wet AMD and atrophic or dry AMD. Wet AMD is caused by the growth of choroidal blood vessels in the retinal layers. Anti–vascular endothelial growth factor (anti-VEGF) treatments have been used more recently to stop the progression of AMD. Brolucizumab is an anti-VEGF that has shown some promise in early results. This study aimed to assess the long-term efficacy and safety of brolucizumab by using real-world evidence over a 1-year period in which patients were treated with the medication.

All participants in this study were patients at the Ophthalmology Clinic of the University of Campania in Naples, Italy. Patients were excluded if they had other ocular pathologies, had previous treatments with brolucizumab, or had a laser photocoagulation or vitrectomy performed within the previous 6 months. Patients were divided into 2 groups, where 1 group had treatment-naive eyes and the other did not. All eyes were subject to an assessment of their best corrected visual acuity (BCVA) and to spectral-domain optical coherence tomography (SD-OCT) imaging. Central retinal thickness (CRT) was also measured in all eyes.

Brolucizumab can help treat patients with AMD | Image credit: Andrey Popov - stock.adobe.com

Change in BCVA and CRT after 6 and 12 months was the primary end point of the study. Secondary end points included any potential adverse events.

There were 44 eyes from 44 patients included in the study; 25 of the patients were men. The mean (SD) age was 77 (5.3) years. A total of 3.7 (1.9) mean injections were performed in the participants, with no significant difference between the 2 groups in terms of number of injections.

There was an improvement in BCVA across both groups after 6 months, with the overall cohort having an improvement of 5 letters (mean [SD], 35 [16] letters vs 30 [17] letters) compared with baseline. The treatment-naive eyes had slightly higher BCVA compared with the group that was not treatment naive, but these differences were not significant (38 [17] letters and 32 [15] letters). The improvement in the overall cohort continued after 12 months compared with baseline (39 [15] letters vs 30 [17] letters). The difference in treatment-naive eyes compared with eyes that were not treatment naive continued after 12 months but was not statistically significant (42 [14] letters vs 35 [14] letters). The overall cohort had improvements of CRT at both 6 months (281 [117] μ vs 360 [129] μ) and 12 months (265 [89] μ vs 360 [129] μ) compared with baseline, with no significant difference between the 2 groups.

Adverse events were not reported in any patients who were not treatment naive whereas 1 case of acute-onset intermediate uveitis was reported in 1 treatment-naive individual. The adverse event was resolved. Fluid distribution at baseline was also not correlated with visual recovery.

There were some limitations to this study. The cohort was small and may not be generalizable to the other areas. The study was retrospective, which could limit the ability to find causal relationships. The cohort was only followed for 1 year, indicating that further follow-up is needed to establish the safety and efficacy of brolucizumab.

The researchers concluded that brolucizumab was both safe and effective in treating wet AMD for patients who were either treatment naive or had received prior treatment. Due to the short timespan and smaller cohort, the researchers said that “prospective studies with longer follow-up and larger cohorts are needed to better study the long-term effects and any adverse reactions attributable to brolucizumab therapy.”

References

1. Rossi S, Gesualdo C, Marano E, et al. Treatment of neovascular age-related macular degeneration: one year real-life results with intravitreal brolucizumab. Front Med. 2025;11:1467160. doi:10.3389/fmed.2024.1467160
2. Age-related macular degeneration (AMD). Johns Hopkins Medicine. Accessed February 4, 2025. https://www.hopkinsmedicine.org/health/conditions-and-diseases/agerelated-macular-degeneration-amd