One-Year and 18-Month Outcomes in nAMD Patient Eyes Switched to Brolucizumab Alone versus to Brolucizumab Alternating with Other Anti-VEGF Agents

Objective: Retrospective, real-world study to evaluate visual acuity (VA), anti-vascular endothelial growth factor (anti-VEGF) injection intervals, and central macular thickness (CMT) in neovascular age-related macular degeneration (nAMD) eyes switched to brolucizumab only or to brolucizumab alternating with another anti-VEGF. Methods: The overall study population comprised eyes that were given [greater than or equal to] 1 brolucizumab injection between 1 October 2019 and 30 November 2021. The brolucizumab-only (BRO) cohort consisted of prior anti-VEGF-treated eyes treated exclusively with [greater than or equal to] 3 brolucizumab injections over [greater than or equal to] 12 or [greater than or equal to] 18 months; the alternating brolucizumab (ALT) cohort comprised prior anti-VEGF-treated eyes treated with [greater than or equal to] 2 brolucizumab injections and [greater than or equal to] 1 other anti-VEGF over [greater than or equal to] 12 or [greater than or equal to] 18 months. Results: A total of 482 eyes received[greater than or equal to] >1 brolucizumab injection during the study period. Mean VA changes from baseline were -1.1 [+ or -] 15.1 letters (BRO cohort; n = 174) and 1.3 [+ or -] 13.0 letters (ALT cohort; n = 47) at Month 12, and 0.0 [+ or -] 13.5 letters (BRO cohort; n = 95) and -7.3 [+ or -] 17.2 letters (ALT cohort; n = 29) at Month 18. Mean changes in injection intervals were +26.9 [+ or -] 48.1 days (BRO cohort) and +11.1 [+ or -] 17.3 days (ALT cohort) at Month 12 and +36.3 [+ or -] 52.3 days (BRO cohort) and +14.0 [+ or -] 19.9 days (ALT cohort) at Month 18. Mean changes in CMT were -35.2 [+ or -] 108.1 pm (BRO cohort) and -31.5 [+ or -] 91.2 [ILLUSTRATION OMITTED] m (ALT cohort) at Month 12 and -38.9 [+ or -] 75.0 [micro]m (BRO cohort) and -9.0 [+ or -] 59.9 [micro]m (ALT cohort) at Month 18. Intraocular inflammation-related adverse events were recorded in 22/482 (4.6%) eyes. Conclusion: Treatment with either brolucizumab alone or brolucizumab alternating with another anti-VEGF can preserve vision, reduce CMT, and extend anti-VEGF injection intervals in patients with nAMD. Keywords: alternating anti-VEGF treatments, brolucizumab, neovascular age-related macular degeneration, wet age-related macular degeneration, 12-month outcomes, 18-month outcomes