Switching to brolucizumab improves visual acuity in nAMD

Switching from other anti-VEGF* agents to brolucizumab only helps improve visual acuity and reduces disease activity in patients with neovascular (wet) age-related macular degeneration (nAMD). 

This was the finding of the phase IIIb, 48-week, ongoing SWIFT study presented at ARVO 2023. [Abstract 465]

nAMD is the most common cause of permanent vision impairment and blindness among the elderly. “There’s a benefit to switching to brolucizumab in these patients,” said study author Dr Ramin Tadayoni, head of the Department of Ophthalmology at Lariboisière and Saint-Louis University Hospitals in Paris, France. “I do recommend this treatment.”

nAMD population

Patients included in the study (n=295) had been treated with other anti-VEGF agents but with suboptimal responses. The mean age of the patients was 76 years; 62 percent were female. 

Patients had choroidal neovascularization (CNV) lesions diagnosed within the past 18 months while undergoing treatment and had best corrected visual acuity (BCVA) of ≤83 and at least 38 ETDRS letters.

Following other anti-VEGF therapies, patients were switched to brolucizumab injections (week 0 and week 8), then to a treat-to-control maintenance phase with a treatment interval, that was extended if patients did not experience changes in visual acuity or other signs of disease.

The frequency of brolucizumab administration was shortened by 4 weeks or to a minimum interval of 8 weeks if symptoms were present at any visit. Patients who required injections every 4 weeks after the loading phase were discontinued on brolucizumab and moved to standard care.

Disease activity at week 16

The primary endpoint of the study was the proportion of patients with no disease activity by investigator assessment at week 16, which was recorded at 40.4 percent, with consistent benefit across subgroups.

“Additionally, there was a mean increase in BCVA of 4.1 letters from baseline and a mean decrease in central subfield thickness (CSFT) of −51 µm,” Tadayoni added.

Eighty-five percent of patients had subretinal fluid (SRF) – a marker of active neovascularization in AMD – at baseline which dropped to 53 percent at week 16.

Importantly, the incidence of dry retina improved from 1.4 percent at baseline to 31.3 percent following brolucizumab treatment.

“Better disease control translated into improvements in visual acuity,” Tadayoni reported. “The CNV lesion area also decreased in size [-0.24 mm²] in parallel to better disease control.”

Overall, ocular-related adverse events occurred in 33.9 percent of the patients, with retinal vasculitis and endophthalmitis reported in about 12.9 percent.

Of these, nine were considered noninflammatory. There was intraocular inflammation only in 20 patients, inflammation plus retinal vasculitis in six, and inflammation plus retinal vascular occlusion in two. At least one patient had inflammation and retinal vasculitis and retinal vascular infusion. The incident rate per 1,000 injections was 12.50, 3.75, 1.25, and 0.63, respectively.

Brolucizumab has a “favourable safety profile” in patients who are not otherwise controlled by other anti-VEGF agents, said Tadayoni. However, outcomes from follow-up study are still being analysed.

Anti-VEGF agents have become the standard of care for the treatment of nAMD, but frequent intravitreal injections present a significant burden to patients. Undertreatment due to nonadherence to a particular treatment regimen puts the patient at risk of vision loss over time.

The advantage of brolucizumab – US FDA-approved for nAMD in 2019 – lies in its longer interval (8–12 weeks) between injections, allowing for reduced injection burden to patients.