Initial experience in treating polypoidal choroidal vasculopathy with brolucizumab in Indian eyes – A multicenter retrospective study

Abstract

Purpose: To report the initial experience of managing treatment-resistant and treatment-naïve eyes with polypoidal choroidal vasculopathy (PCV) by using brolucizumab 6 mg. Methods: This was a retrospective multicentric series of all consecutive eyes with PCV treated with brolucizumab. Treatment resistance was defined as taking at least six prior anti-VEGF injections over the past 1 year and showing persistent disease activity in the form of intra (IRF) or subretinal fluid (SRF) or both. All patients were treated on a pro re nata (PRN) basis and followed up monthly. Retreatment was considered when either SRF or IRF were present at any time point during the study. Results: We included 21 eyes of 21 patients with PCV with a mean age of 65.1 ± 9.9 years, of which 16 eyes (76%) were treatment-resistant. The mean follow-up period from receiving the first brolucizumab was 27.3 ± 3.3 weeks. Of the 21 eyes, seven eyes (33%) received three injections during follow-up, 13 eyes (62%) received two injections, and one eye received one injection. The mean injection-free interval was 12 ± 1.2 weeks. The median pretreatment vision was 0.6 logMAR (IQR = 0.47–1 logMAR) and improved to 0.3 logMAR (IQR = 0.25–0.6 logMAR), whereas the mean macular thickness improved from 443 ± 60 mm at baseline to 289 ± 25 mm ( P < 0.001) at the last follow-up period. None of the eyes experienced any intraocular inflammation across 48 injection sessions Conclusion: Brolucizumab is safe and effective in controlling PCV disease in both treatment-resistant and treatment-naïve eyes.

Brolucizumab in Pretreated Neovascular Age-Related Macular Degeneration: Case Series, Systematic Review, and Meta-Analysis

“…Three papers with four subgroups reported change of treatment intervals: Ueda-Consolve et al reported an increase from 7.4 ± 1.4 weeks to 11.6 ± 2.6 weeks after the switch in 19 eyes with type 1 macular neovascularization and from 6.9 ± 1.3 weeks to 11.7 ± 3.1 weeks after the switch in 23 eyes with polypoidal choroidal vasculopathy after 18 months [ 21 ]. Giunta et al showed an increase from 4.7 ± 2.3 weeks to 6.8 ± 2.8 weeks in a cohort of 73 patients at least three months after the switch to brolucizumab [ 22 ].…”

Review on the Safety and Efficacy of Brolucizumab for Neovascular Age-Related Macular Degeneration From Major Studies and Real-World Data

“…Important points and outcomes from real-world data are outlined in Table 1. 28,29,[38][39][40][41][42][43][44] The readers are encouraged to access individual studies for details of methodology and results.…”

Commentary: Managing treatment-resistant polypoidal choroidal vasculopathy – Evolving concepts

“…has shown promising initial results of pro re nata Brolucizumab therapy in recalcitrant PCV eyes in Indian settings. [ 9 ] It helped in reducing subretinal/intraretinal fluid, PED height and in maintaining visual acuity gains. HAWK Phase III trial subanalysis also reported that visual outcomes achieved with brolucizumab q12w/q8w treatment over 96 weeks were comparable with aflibercept treatment on a fixed q8w dosing.…”

“…In the study conducted by Chakraborty et al , no such events were found. [ 9 ] This could be due to the differential racial response and pro re nata dosing regimen usage which might have reduced the antigenic load caused due to frequent repeated injections. Novartis has also communicated that Brolucizumab should not be administered at intervals of less than 2 months after three monthly loading doses.…”