Real-World Experience With Brolucizumab 6 mg for Diabetic Macular Edema

Abstract

Background This study aimed to assess functional and anatomical outcomes after one month of treatment with a single intravitreal injection (IVI) of brolucizumab in patients with diabetic macular edema (DME). Methodology A retrospective study was conducted on eyes with DME who received a single IVI of brolucizumab. The study was designed to assess visual function and optical coherence tomography (OCT) biomarkers at baseline and one month following a single brolucizumab IVI. A sub-analysis was conducted between the following two groups: group 1 - treatment with brolucizumab due to burden, needle phobia, or non-compliance (responders to standard anti-vascular endothelial growth factor (VEGF) or naïve); and group 2 - non-responsive to previous therapies (standard anti-VEGF ± corticosteroids). The main outcome measures included best-corrected visual acuity (BCVA; Early Treatment of Diabetic Retinopathy Study (ETDRS) letters), central foveal thickness, and OCT biomarkers such as the presence of subretinal fluid, the number of hyperreflective dots, the disorganization of retinal inner layers, the disruption of outer plexiform layer, external limiting membrane and ellipsoid zone, the presence of cysts in the nuclear layers (outer (ONL) and inner (INL)), and the number of cysts in ONL versus those in the INL. Safety outcomes were assessed. Results A total of 59 eyes from 42 patients were included, of which 47 eyes were in group 1 and 12 eyes were in group 2. At one month, patients had an improvement of two ETDRS letters on BCVA (p = 0.020), lower central foveal thickness (p < 0.001), fewer hyperreflective dots (p = 0.016), less outer plexiform layer disruption (p = 0.004), less inner and outer nuclear layer cysts (p < 0.001 and p = 0.001, respectively) and better relationship between ONL and INL cysts (p = 0.022). Results were significant in the subgroup of patients with previous responsive DME. No adverse events were reported. Conclusions This study demonstrates the effectiveness and safety after one injection of brolucizumab 6 mg in the management of DME, especially in previously responsive DME patients.