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Boudousq C, Nguyen V, Hunt A, Gillies M, Zarranz-Ventura J, O'Toole L, Mangelschots E, Kusenda P, Schmidt-Erfurdt U, Pollreisz A, Kheir WJ, Arruabarrena C, Vujosevic S, Barthelmes D, Creuzot-Garcher C, Gabrielle PH. European Unmet Needs in the Management of Neovascular Age-Related Macular Degeneration in Daily Practice: Data from the Fight Retinal Blindness! Registry. Ophthalmol Retina 2024; 8:527-536. [PMID: 38185453 DOI: 10.1016/j.oret.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/09/2024]
Abstract
PURPOSE To evaluate the proportion, predictors, and outcomes of patients with neovascular age-related macular degeneration (nAMD) treated with a high burden of VEGF inhibitor intravitreal (IVT) injections after 2 years in routine clinical practice. DESIGN Retrospective analysis of data from a prospectively designed observational outcomes registry, the Fight Retinal Blindness! Project, of patients treated in European centers. PARTICIPANTS Treatment-naïve eyes (1 eye per patient) starting VEGF inhibitors for nAMD from January 2017 to March 2020 with 24 months of follow-up. We analyzed the following 3 treatment-burden groups defined by the mean interval of the 3 closest injections to the 24-month visit: (1) those with a high-treatment burden had injection intervals ≤ 42 days, (2) those with a low-treatment burden had injection intervals between 43 and 83 days; and (3) those with tolerable treatment burden had injection intervals between 84 and 365 days. METHODS Multinomial regression was used to evaluate baseline risk predictors of patients requiring a high-treatment burden. MAIN OUTCOME MEASURES The proportion of patients that experienced a high-treatment burden at 2 years and its predictors. RESULTS We identified 2038 eligible patients completing 2 years of treatment (2038/3943 patients [60%]) with a median (quartile 1, quartile 3) of 13 (10, 17) injections. The proportion of patients with a high-treatment burden was 25% (516 patients) at 2 years. Younger patients (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.96-0.99; P < 0.01) were more likely to have high-treatment burden, whereas eyes with type 3 choroidal neovascular lesions at baseline were significantly less likely (OR, 0.26; 95% CI, 0.13-0.52; P < 0.01). Regarding type of fluid, patients with subretinal fluid only at baseline (OR, 3.85; 95% CI, 1.34-11.01; P = 0.01) and persistent active intraretinal (OR, 1.56; 95% CI, 1.18-2.06; P < 0.01) or subretinal fluid only (OR, 2.21; 95% CI, 1.52-3.21; P < 0.01) after the loading phase had a higher risk of high treatment burden at 2 years. CONCLUSIONS High treatment burden is a common issue in routine clinical practice in Europe, with a quarter of patients requiring injections of conventional VEGF inhibitors every 6 weeks at 2 years and 40% discontinuing treatment within 2 years. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Clotilde Boudousq
- Department of Ophthalmology, Dijon University Hospital, Dijon, France
| | - Vuong Nguyen
- The University of Sydney, Sydney Medical School, Discipline of Ophthalmology, Save Sight Institute, Sydney, New South Wales, Australia
| | - Adrian Hunt
- The University of Sydney, Sydney Medical School, Discipline of Ophthalmology, Save Sight Institute, Sydney, New South Wales, Australia
| | - Mark Gillies
- The University of Sydney, Sydney Medical School, Discipline of Ophthalmology, Save Sight Institute, Sydney, New South Wales, Australia
| | - Javier Zarranz-Ventura
- Hospital Clinic de Barcelona, Universitat de Barcelona, Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Louise O'Toole
- Department of Ophthalmology, Mater Private Network, Dublin, University College Dublin, Ireland
| | | | - Pavol Kusenda
- Department of Ophthalmology, University Hospital - St. Michael's Hospital, Bratislava, Slovakia
| | | | - Andreas Pollreisz
- Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria
| | - Wajiha Jurdi Kheir
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Carolina Arruabarrena
- Department of Ophthalmology, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - Stela Vujosevic
- Eye Clinic, IRCCS MultiMedica, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milano, Milan, Italy
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Pierre-Henry Gabrielle
- Department of Ophthalmology, Dijon University Hospital, Dijon, France; The University of Sydney, Sydney Medical School, Discipline of Ophthalmology, Save Sight Institute, Sydney, New South Wales, Australia.
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Huang YT, Tien PT, Chen PY, Yang CL, Chen SN. Comparative efficacy of brolucizumab, half-dose photodynamic therapy, and aflibercept in managing chronic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2024; 262:1755-1763. [PMID: 38224344 DOI: 10.1007/s00417-024-06373-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/03/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024] Open
Abstract
PURPOSE To compare the efficacy of brolucizumab, half-dose PDT, and aflibercept in treating chronic central serous chorioretinopathy (CSC). METHODS A retrospective cohort study with chronic CSC patients who underwent intravitreal injection of one shot of brolucizumab or aflibercept in the first 3 months, followed by pro re nata regimens or a single session of half-dose PDT, was retrospectively reviewed. The primary outcome measure was the proportion of eyes that achieved complete absorption of retinal fluid without requiring any rescue treatment. Secondary outcomes included changes in best-corrected visual acuity (BCVA), central retinal thickness (CRT), and central choroidal thickness (CCT). RESULTS A total of 54 consecutive patients were included in this study with 18 patients in each group. At months 1 and 2, the brolucizumab group exhibited the highest rate of complete retinal fluid resolution (61% and 77%), followed by the half-dose PDT group (56% and 72%), and lowest in the aflibercept group (28% and 33%), with statistically significant differences noted at month 2 (P = 0.012). The brolucizumab group also demonstrated the most significant reduction in CCT at months 1 and 2 among the three groups (P = 0.007 and 0.001). Recurrence of retinal fluid in the brolucizumab groups was predominantly observed at month 3. Conversely, the half-dose PDT group exhibited the most favorable anatomical results starting from month 3. Notably, mild vitritis was observed in one case from the brolucizumab group. CONCLUSIONS Single injection of brolucizumab demonstrates trends of faster regression of persistent residual retinal fluid, greater CCT and CRT decline, and matched BCVA compared to half-dose PDT in the short term.
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Affiliation(s)
- Yu-Te Huang
- Department of Ophthalmology, Eye Center, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, 40447, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, Eye Center, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, 40447, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Po-Yu Chen
- Department of Ophthalmology, Eye Center, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, 40447, Taiwan
| | - Chi-Lan Yang
- Department of Ophthalmology, Eye Center, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, 40447, Taiwan
| | - San-Ni Chen
- Department of Ophthalmology, Eye Center, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, 40447, Taiwan.
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
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Cennamo G, Rinaldi M, Malvone E, Costagliola C. Choroidal Thickness and brolucizumab intravitreal injection: Cause or effect of intraocular inflammation? Photodiagnosis Photodyn Ther 2024; 47:104072. [PMID: 38556186 DOI: 10.1016/j.pdpdt.2024.104072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/19/2024] [Accepted: 03/29/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE to analyze the structural changes of choroidal thickness in patients with brolucizumab-related exudative vitritis after intravitreal injection, using EDI-OCT. METHODS One hundred eyes of one hundred patients, affected by exudative age related-macular degeneration treated with brolucizumab intravitreal injection between January 2022 and august 2023 at Eye clinic of University of Federico II Naples, were enrolled. All eyes underwent macular examination using Enhanced Deep Imaging-OCT (Spectralis, Heidelberg Engineering inc.) preoperatively and at each postoperative check (1, 3, 6, 12 months). Anterior segment evaluation at slit lamp before and after injection was performed. RESULTS Of the 100 treated eyes, 4 showed inflammatory signs related to exudative vitreitis, with inflammation signs at slit lamp examination and confirmed by OCT and B scan ecography. EDI-OCT revealed, in all of these 4 patients, a significant increase of choroidal thickness compared to baseline. CONCLUSION choroidal thickness could be correlated in the inflammatory response generated in patients undergoing treatment with brolucizumab.
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Affiliation(s)
- Gilda Cennamo
- Department of Neuro sciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy.
| | - Michele Rinaldi
- Department of Neuro sciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Emanuele Malvone
- Department of Neuro sciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Ciro Costagliola
- Department of Neuro sciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
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Sadda S, Sarraf D, Khanani AM, Tadayoni R, Chang AA, Saffar I, Gedif K, Wong DT. Comparative assessment of subretinal hyper-reflective material in patients treated with brolucizumab versus aflibercept in HAWK and HARRIER. Br J Ophthalmol 2024; 108:852-858. [PMID: 37669850 PMCID: PMC11137441 DOI: 10.1136/bjo-2023-323577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/05/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE Post hoc analysis of the phase III HAWK and HARRIER studies to compare the reductions in subretinal hyper-reflective material (SHRM) thickness following brolucizumab 6 mg or aflibercept 2 mg treatment and to assess SHRM thickness and thickness variability as a potential biomarker of visual outcomes in patients with neovascular age-related macular degeneration (nAMD). METHODS Optical coherence tomography images from the brolucizumab (n=700) and aflibercept (n=696) arms were analysed for the maximum SHRM thickness across the macula over 96 weeks. In a pooled treatment-agnostic analysis, the effect of week 12 SHRM thickness and SHRM thickness variability on best-corrected visual acuity (BCVA) through week 96 were also assessed. RESULTS Brolucizumab was associated with numerically higher percentage reductions from baseline in SHRM thickness versus aflibercept in all patients (week 96: 54.4% vs 47.6%, respectively) and also in the matched subgroups with disease activity at week 16 (week 96: 51.6% vs 33.8%, respectively). In eyes with lower SHRM measurements at week 12, mean BCVA gains from baseline were higher at week 96 (<200 µm, +6.47 Early Treatment Diabetic Retinopathy Study letters; ≥200 µm, +3.10 letters). Eyes with the lowest SHRM thickness variability from week 12 to week 96 showed the greatest mean BCVA gains from baseline (week 96: <12 µm, +7.42 letters; >71 µm, -2.95 letters). CONCLUSIONS In HAWK and HARRIER, greater reductions in maximum SHRM thickness from baseline were observed with brolucizumab compared with aflibercept. Furthermore, the data suggest that SHRM thickness postloading and SHRM thickness variability over time are biomarkers for visual outcomes in patients with nAMD.
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Affiliation(s)
- SriniVas Sadda
- Doheny Eye Institute, University of California, Los Angeles, California, USA
| | - David Sarraf
- Jules Stein Eye Institute, UCLA, Los Angeles, California, USA
| | - Arshad M Khanani
- Sierra Eye Associates and University of Nevada, Reno School of Medicine, Reno, Nevada, USA
| | - Ramin Tadayoni
- Department of Ophthalmology, Université Paris Cité, AP-HP, Lariboisière, Saint Louis and Rothschild Foundation Hospitals, Paris, France
| | - Andrew A Chang
- Sydney Retina Clinic, Sydney Eye Hospital, Sydney University, Sydney, New South Wales, Australia
| | | | | | - David T Wong
- Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
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5
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Kim DJ, Kim DG, Kwak HD, Jang JY, Ji YS, Lee SH, Lee EK, Park KH, Kim JH, Lee JS, Song Y, Kim ST, Shin MH, Kim M, Park SJ, Joo K, Sagong M, Lee CS, Woo SJ. Long-term efficacy and safety of brolucizumab in neovascular age-related macular degeneration: A multicentre retrospective real-world study. Acta Ophthalmol 2024. [PMID: 38706195 DOI: 10.1111/aos.16699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/16/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE To investigate the long-term efficacy and safety of intravitreal brolucizumab (BRZ) injections in patients with typical neovascular age-related macular degeneration (typical nAMD) and polypoidal choroidal vasculopathy (PCV). METHODS This multicentre retrospective study included 401 eyes of 398 patients with nAMD who received BRZ injection(s), with a follow-up duration of ≥12 months. Changes in best-corrected visual acuity (BCVA), retinal fluid evaluation and central subfield thickness (CST) on optical coherence tomography were assessed. The efficacy of BRZ was compared between typical nAMD and PCV groups. RESULTS Analyses were conducted with 280 eyes of 278 patients with typical nAMD and 121 eyes of 120 patients with PCV (mean age, 71.1 ± 8.6 years). 29 eyes (7.2%) were treatment naïve. The mean follow-up period was 15.3 ± 2.8 months; the mean number of BRZ injections within 1 year was 4.5 ± 1.7. BCVA was maintained during the follow-up period, and CST significantly improved from the first injection month and was maintained for 12 months in both the typical nAMD and PCV groups. The dry macula proportion increased from 2.7% at baseline to 56.1% at 1 month and 42.9% at 12 months. Among the 18 eyes that underwent indocyanine green angiography both before and after treatment, 10 (55.6%) showed polyp regression. Overall, the incidence of intraocular inflammation (IOI), retinal vasculitis and occlusive retinal vasculitis was 9.4% (38 eyes), 1.2% (5 eyes) and 0.5% (2 eyes), respectively. IOI occurred from the first to the sixth injections, with an average IOI onset of 28.5 ± 1.4 days. All eyes achieved IOI resolution, although the two eyes with occlusive retinal vasculitis showed a severe visual decline after IOI resolution. CONCLUSION Brolucizumab was effective in maintaining BCVA and managing fluid in eyes with nAMD for up to 1 year, exhibiting a high polyp regression rate. However, the not uncommon incidence of IOI and the severe visual decline caused by the rare occlusive retinal vasculitis following BRZ treatment underscore the importance of careful monitoring and timely management.
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Affiliation(s)
- Dong Ju Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Ophthalmology, Hangil Eye Hospital, Incheon, South Korea
- Department of Ophthalmology, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - Dong Geun Kim
- Department of Ophthalmology, Inje University College of Medicine, Inje University Busan Paik Hospital, Busan, South Korea
| | - Hyun Duck Kwak
- Department of Ophthalmology, Inje University College of Medicine, Inje University Busan Paik Hospital, Busan, South Korea
| | | | - Yong-Sok Ji
- Department of Ophthalmology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | | | - Eun Kyoung Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, South Korea
| | | | - Yumi Song
- Kong Eye Hospital, Seoul, South Korea
| | - Seong Taeck Kim
- Department of Ophthalmology, Chosun University School of Medicine, Gwangju, South Korea
| | - Min Ho Shin
- Department of Ophthalmology, Chosun University School of Medicine, Gwangju, South Korea
| | - Min Kim
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kwangsic Joo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, South Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Yoshikawa Y, Sakaki Y, Shinoda K, Kataoka K. Safety and Effectiveness of Intravitreal Brolucizumab Injection in Combination With Sub-Tenon's Capsule Triamcinolone Acetonide Injection for Polypoidal Choroidal Vasculopathy During the Loading Phase. Cureus 2024; 16:e59481. [PMID: 38832144 PMCID: PMC11145932 DOI: 10.7759/cureus.59481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND This study evaluated the safety and effectiveness of combining intravitreal brolucizumab injection with sub-tenon's capsule triamcinolone acetonide injection (STTA) during the loading phase for polypoidal choroidal vasculopathy (PCV). METHODS In this retrospective observational study, untreated patients with PCV receiving intravitreal brolucizumab injections with STTA during loading at Saitama Medical University Hospital's Eye Center from May 2021 to June 2022 were analyzed. Complete regression rates of polypoidal lesions were assessed using indocyanine green angiography 12 weeks post-treatment initiation. RESULTS Nineteen patients (19 eyes) participated. Best-corrected visual acuity significantly improved at eight weeks compared to baseline. No significant intraocular pressure increases occurred throughout the loading phase, while central foveal and choroidal thickness significantly reduced at 4, 8, and 12 weeks. Subretinal fluid was present in all patients before treatment, rapidly resolving post-intravitreal brolucizumab injections and STTA, with residual rates of 36.8% (seven eyes) and 5.3% (one eye) at four and 12 weeks, respectively. Intraocular inflammation did not occur during the loading phase, and the complete regression rate of polypoidal lesions was 89.5% (17 eyes). CONCLUSIONS Combining intravitreal brolucizumab injection with STTA during the loading phase may be one treatment option for PCV management.
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Affiliation(s)
| | - Yu Sakaki
- Ophthalmology, Kozawa Eye Hospital and Diabetes Center, Ibaraki, JPN
| | - Kei Shinoda
- Opthalmology, Saitama Medical University, Saitama, JPN
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Airody A, Baseler HA, Seymour J, Allgar V, Mukherjee R, Downey L, Dhar-Munshi S, Mahmood S, Balaskas K, Empeslidis T, Hanson RLW, Dorey T, Szczerbicki T, Sivaprasad S, Gale RP. Treatment of age-related macular degeneration with aflibercept using a treat, extend and fixed protocol; A 4-year study of treatment outcomes, durability, safety and quality of life (An extension to the MATE randomised controlled trial). Acta Ophthalmol 2024; 102:e328-e338. [PMID: 37776074 DOI: 10.1111/aos.15774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/05/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE Data are limited pertaining to the long-term benefits of aflibercept treatment for neovascular age-related macular degeneration (nAMD). The aim of this study was to provide outcomes, safety, durability and quality-of-life data with aflibercept using a modified treat, extend and fixed regime over 4 years. METHODS Prospective, multicentre, single cohort observational study of treatment-naïve nAMD participants treated with aflibercept as 2-year extension of the MATE-trial that compared early and late Treat-and-Extend for 2 years. Refracted ETDRS best corrected visual acuity (BCVA), central retinal thickness (CRT), treatment interval and adverse events were assessed. Quality-of-life was measured using the Macular Disease Dependent Quality of Life (MacDQoL) and Macular Disease Treatment Satisfaction Questionnaires (MacTSQ). RESULTS Twenty-six of 40 participants completing the MATE-trial were enrolled with 20 completing the total 4-year study. Mean BCVA was 60.7 at Month 0 and 64.8 ETDRS letters at Month 48 while CRT decreased from 423.7 μm to 292.2 μm. Five participants discontinued treatment due to inactivity. The mean number of treatments and visits for the remaining participants was 27 and 30.0, respectively, with treatment intervals extended to 12 weeks in four participants at Month 48. Both AMD-specific QoL and treatment satisfaction remained stable between Months 0 and 48 and mean BCVA significantly correlated with AMD-specific QoL scores at Months 12, 24 and 48. CONCLUSIONS Results suggest that BCVA can be maintained over 48 months when following a treat-extend-and-fix regimen of aflibercept with intervals out to 12 weeks, while maintaining AMD-specific QoL and treatment satisfaction.
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Affiliation(s)
- Archana Airody
- Academic Unit of Ophthalmology, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
- Hull York Medical School, University of York, York, UK
| | - Heidi A Baseler
- Hull York Medical School, University of York, York, UK
- Department of Psychology, University of York, York, UK
| | - Julie Seymour
- Hull York Medical School, University of Hull, Hull, UK
| | - Victoria Allgar
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | | | | | - Sushma Dhar-Munshi
- Kings Mill Hospital, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield, UK
| | | | - Konstantinos Balaskas
- University of Manchester, Manchester, UK
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Theo Empeslidis
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Rachel L W Hanson
- Academic Unit of Ophthalmology, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
- Hull York Medical School, University of York, York, UK
| | - Tracey Dorey
- Academic Unit of Ophthalmology, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Tom Szczerbicki
- Academic Unit of Ophthalmology, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Richard P Gale
- Academic Unit of Ophthalmology, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
- Hull York Medical School, University of York, York, UK
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Abu Serhan H, Taha MJJ, Abuawwad MT, Abdelaal A, Irshaidat S, Abu Serhan L, Abu Salim QF, Awamleh N, Abdelazeem B, Elnahry AG. Safety and Efficacy of Brolucizumab in the Treatment of Diabetic Macular Edema and Diabetic Retinopathy: A Systematic Review and Meta-Analysis. Semin Ophthalmol 2024; 39:251-260. [PMID: 37849309 DOI: 10.1080/08820538.2023.2271095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE To investigate the efficacy and safety of brolucizumab in diabetic macular edema (DME) and diabetic retinopathy (DR). METHODS In this systematic review and meta-analysis, an electronic search was done to acquire all articles describing brolucizumab use in patients with DME and DR. The review was prospectively registered on PROSPERO (CRD42022382625). Collected articles were filtered through two stages by independent reviewers. Data were extracted from the included articles and then analyzed accordingly. RESULTS Brolucizumab induced significant improvement in best-corrected visual acuity and was either better or non-inferior to other types of anti-VEGF (MD -0.64 mu, 95% CI [-1.15, -0.13], P = .01); the same observation was noted with regards to central subfield macular thickness (CSMT) (MD -138.6 mu, 95% CI [-151.9, -125.3], P = .00001). Brolucizumab was reported to be relatively safe for use in diabetic patients, with few adverse events observed, with a higher frequency of adverse events in relation to the 3 mg dose compared to the 6 mg dose. CONCLUSION Brolucizumab is a new drug that has potential advantages in efficacy over other anti-VEGF agents in the treatment of DME and DR. It showed significant improvement in BCVA and CSMT with the possibility of a lower dosing schedule compared to other agents. Although observed in low frequency, sight-threatening adverse effects appear to occur more frequently compared to other anti-VEGF agents. The main observed adverse event was retinal vasculitis which was seen more commonly with the 3 mg dose versus the 6 mg dose.
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Affiliation(s)
- Hashem Abu Serhan
- Department of Ophthalmology, Hamad Medical Corporations, Doha, Qatar
| | | | | | - Abdelaziz Abdelaal
- Harvard Medical School, Postgraduate Medical Education, Boston, USA
- Doheny Eye Institute, University of California, Los Angeles, USA
| | - Sara Irshaidat
- Department of Pediatrics, King Hussein Cancer Centre, Amman, Jordan
| | | | | | - Nour Awamleh
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Basel Abdelazeem
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Ayman G Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
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Zarbin MA, MacCumber MW, Karcher H, Adiguzel E, Mayhook A, LaPrise A, Bilano VL, Igwe F, Ip MS, Wykoff CC. Real-World Safety Outcomes with Brolucizumab in Neovascular Age-Related Macular Degeneration: Findings from the IRIS® Registry. Ophthalmol Ther 2024; 13:1357-1368. [PMID: 38520643 DOI: 10.1007/s40123-024-00920-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/27/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION To assess real-world safety outcomes for adults with neovascular age-related macular degeneration (nAMD) treated with brolucizumab from the US-based IRIS® (Intelligent Research in Sight) Registry. METHODS In this retrospective study, 18,312 eyes (15,998 patients) treated with ≥ 1 intravitreal brolucizumab injections between 8 October 2019 (US launch date for brolucizumab) and 7 October 2021 were followed up for ≤ 2 years after first injection (index date). The study assessed the predefined incident ocular adverse events of intraocular inflammation (IOI), retinal vasculitis (RV), and retinal vascular occlusion (RO). RESULTS Overall, 614/18,312 eyes (3.4%) experienced any IOI, RV, and/or RO event. Median (interquartile range [IQR]) time to an event was 84 (42-167) days; 77.4% of events (475/614) occurred within 6 months after index date. Median (IQR) number of brolucizumab injections before an event was 2 (1-4). For eyes with an adverse event and visual acuity (VA) data (n = 406), median (IQR) change in Early Treatment of Diabetic Retinopathy Study (ETDRS) letters from pre-event VA was 0 (- 7 to + 5) at the 6-month follow-up; 50 eyes (12.3%) had a VA loss of 10 or more ETDRS letters. Risk of an event (hazard ratio [95% confidence interval]) was decreased in eyes from male patients (0.61 [0.53-0.71]), from older patients (0.83 [0.76-0.90]), from treatment-naive patients (0.51 [0.38-0.69]), and from patients who started brolucizumab in the second year after launch (0.68 [0.53-0.86] vs. first year). CONCLUSION In this large real-world brolucizumab safety study, 3.4% of eyes experienced an IOI, RV, and/or RO event. Among eyes that experienced an adverse event for which VA data were available, median ETDRS vision change was 0 letters (IQR - 7 to + 5).
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Affiliation(s)
- Marco A Zarbin
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Rutgers University, 90 Bergen Street, Room 6155, Newark, NJ, 07103, USA.
| | - Mathew W MacCumber
- Department of Ophthalmology, Rush University Medical Center, Chicago, IL, USA
- Illinois Retina Associates, Chicago, IL, USA
| | | | - Eser Adiguzel
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | | | | | - Michael S Ip
- Doheny Eye Institute, University of California, Los Angeles, CA, USA
| | - Charles C Wykoff
- Retina Consultants of Texas, Houston, TX, USA
- Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
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10
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Hong SH, Kim HD. Central retinal artery occlusion after intravitreal brolucizumab injection for treatment-naïve neovascular age-related macular degeneration; a case report. BMC Ophthalmol 2024; 24:200. [PMID: 38679743 PMCID: PMC11057157 DOI: 10.1186/s12886-024-03452-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/11/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND To report a case of central retinal artery occlusion (CRAO) after intravitreal injection of brolucizumab for a treatment-naïve neovascular age-related macular degeneration (nAMD) patient without comorbid cardiovascular disease history. CASE PRESENTATION A 79-year-old Asian male without a cardiovascular disease history such as diabetes or hypertension underwent three times of monthly consecutive intravitreal brolucizumab injections for treatment of progressed nAMD in his left eye. Two days after the third injection, the patient presented with acute painless visual loss. Typical retinal whitening with a cherry red spot was observed on the fundus photograph, and retinal swelling with hyper-reflectivity was also identified on the optical coherence tomography (OCT) scan. On the fundus fluorescein angiography, arm-to-retina time and arteriovenous transit time were remarkedly delayed, but clinical findings suggesting an intraocular inflammation (IOI) were not observed. Therefore, CRAO was diagnosed, and anterior chamber paracentesis was administrated immediately. However, there had been no improvement in visual acuity during the follow-up period of three months, despite prolonged oral steroid and anti-platelet agent medication. CONCLUSIONS In rare cases, patients without cardiovascular comorbidities can develop CRAO after intravitreal brolucizumab injection without gross evidence of IOI. Therefore, CRAO should always be in consideration and careful observation is required after intravitreal brolucizumab injection for nAMD patients with old age, even if the patient does not have any other cardiovascular disease history.
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Affiliation(s)
- Sung Hwa Hong
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Hoon Dong Kim
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea.
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11
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Weng CC, Chi SC, Lin TC, Huang YM, Chou YB, Hwang DK, Chen SJ. Brolucizumab in recalcitrant neovascular age-related macular degeneration-real-world data in Chinese population. PLoS One 2024; 19:e0301096. [PMID: 38564612 PMCID: PMC10986944 DOI: 10.1371/journal.pone.0301096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
This retrospective study aimed to determine the short-term efficacy and safety of brolucizumab treatment for recalcitrant neovascular age-related macular degeneration (nAMD) in a real-world setting in Taiwan. Recalcitrant nAMD patients who were treated with brolucizumab from November 2021 to August 2022 at Taipei Veterans General Hospital were included. Patients were followed for 3 months after switching to brolucizumab. The primary outcomes were changes in mean best-corrected visual acuity (BCVA) and central retinal thickness (CRT) from baseline to the third month. The secondary outcomes included the incidence of intraocular inflammation (IOI), proportion of patients with subretinal and intraretinal fluid (SRF and IRF), and change in pigment epithelial detachment (PED) height from baseline to the third month. The significance level was considered as p < .05 in all tests. A total of 38 patients (40 eyes) with a mean (±SD) age of 76.3 (±10.84) years were included. The baseline BCVA was 0.92±0.64 logMAR, and the CRT and PED height were 329.0±171.18 and 189.8±114.94 um, respectively. The patients had a significant reduction in CRT and resolution of IRF and SRF from baseline to the third month. There were numerical improvements in mean BCVA and PED height, but they were not significant. The percentages of achieving at least 0.1, 0.2, and 0.3 logMAR (equivalent to 5, 10, 15 ETDRS letters) visual gain were 50%, 37.5%, and 30%, respectively, during the first 3 months of follow-up. No IOI occurred in these patients. This study demonstrated that brolucizumab had good short-term structural and functional efficacy in recalcitrant nAMD patients.
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Affiliation(s)
- Chang-Chi Weng
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Sheng-Chu Chi
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Tai-Chi Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Yi-Ming Huang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Yu-Bai Chou
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - De-Kuang Hwang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
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12
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Bilgic A, Kodjikian L, de Ribot FM, Spitzer MS, Vasavada V, Gonzalez-Cortes JH, Sudhalkar A, Chakraborty S, Mathis T. Real-world experience with brolucizumab in neovascular age-related macular degeneration over 2 years: the REBA extension study. Graefes Arch Clin Exp Ophthalmol 2024; 262:1161-1167. [PMID: 38063874 DOI: 10.1007/s00417-023-06329-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/05/2023] [Accepted: 11/23/2023] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND To determine long-term efficacy and safety of intravitreal brolucizumab therapy for neovascular age-related macular degeneration (nAMD) in the real-world setting. METHODS Retrospective, observational, multicentric study and an extension of the REBA study (Real-world Experience with Brolucizumab in nAMD) to 24 months. The study entailed follow-up of 91 consecutive eyes (67 patients) with nAMD who received brolucizumab therapy and completed 24 months of follow-up. Both treatment-naïve and switch therapy patients were included. All relevant data were collected. The primary outcome measure was changed in best-corrected visual acuity (BCVA) over time. Secondary outcome measures included change in central subfield thickness (CST) and complications. RESULTS The mean (SD) baseline BCVA was 48.4 (3.5) letters and 36.2 (7.1) letters in treatment-naïve group and switch therapy group, respectively. BCVA gain was + 9.2 (3.7) letters (p = 0.01) and + 7.7 (3.4) letters (p = 0.011), respectively. The change in mean (SD) CST has shown a significant decrease in retinal thickness in treatment-naïve group (from 432.5 (68.4) to 283.0 (51.3) µm; p = 0.018) and in switch therapy group (from 452.5 (40.5) to 271.0 (43.4) µm; p = 0.011) group. One switch patient developed vascular occlusion and another a macular hole after the fifth brolucizumab injection as reported in the primary study. Both patients recovered uneventfully. Three patients demonstrated reversible intraocular inflammation between months 10 and 24. CONCLUSION Patients showed a significant anatomical and functional response to brolucizumab therapy in the real world, regardless of prior treatment status, until the end of the follow-up period. Overall, 5 significant untoward events were noted.
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Affiliation(s)
- Alper Bilgic
- Alphavision Augenarztpraxis, 27568, Bremerhaven, Germany.
- MS Sudhalkar Medical Research Foundation, Baroda, 390001, India.
| | - Laurent Kodjikian
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 69004, Lyon, France
- UMR-CNRS 5510, MATEIS, INSA, Université Lyon 1, Villeurbane, 69100, Lyon, France
| | | | - Martin S Spitzer
- Department of Ophthalmology, University of Hamburg, 20246, Hamburg, Germany
| | | | - Jesus Hernan Gonzalez-Cortes
- Ophthalmology Department, School of Medicine, University Hospital "Dr. Jose Eleuterio Gonzalez, Universidad Autónoma de Nuevo León, 64460, Monterrey, Mexico
| | - Aditya Sudhalkar
- Alphavision Augenarztpraxis, 27568, Bremerhaven, Germany.
- MS Sudhalkar Medical Research Foundation, Baroda, 390001, India.
| | | | - Thibaud Mathis
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 69004, Lyon, France
- UMR-CNRS 5510, MATEIS, INSA, Université Lyon 1, Villeurbane, 69100, Lyon, France
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13
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Inoda S, Takahashi H, Maruyama-Inoue M, Ikeda S, Sekiryu T, Itagaki K, Matsumoto H, Mukai R, Nagai Y, Ohnaka M, Kusuhara S, Miki A, Okada AA, Nakayama M, Nishiguchi KM, Takeuchi J, Mori R, Tanaka K, Honda S, Kohno T, Koizumi H, Miyara Y, Inoue Y, Takana H, Iida T, Maruko I, Hayashi A, Ueda-Consolvo T, Yanagi Y. INCIDENCE AND RISK FACTORS OF INTRAOCULAR INFLAMMATION AFTER BROLUCIZUMAB TREATMENT IN JAPAN: A Multicenter Age-Related Macular Degeneration Study. Retina 2024; 44:714-722. [PMID: 38016089 DOI: 10.1097/iae.0000000000004009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/21/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE To investigate the incidence of intraocular inflammation (IOI) and its risk factors following intravitreal injections of brolucizumab for neovascular age-related macular degeneration in Japan. METHODS A total of 1,351 Japanese consecutive patients with neovascular age-related macular degeneration who were treated with brolucizumab from May 2020 to May 2022 at 14 institutions were examined. The variables analyzed were the number of brolucizumab injections, time to onset of IOI, and risk factors. RESULTS Intraocular inflammation developed in 152 eyes (11.3%). Retinal vasculitis and/or retinal occlusion occurred in 53 eyes (3.9%). Ninety-four patients received bilaterally, bilateral IOI occurred in five patients (5.3%). Sixteen eyes (1.2%) had irreversible visual acuity loss and nine eyes (0.67%) had visual loss of three lines or more due to retinal vasculitis and/or retinal occlusion. The cumulative IOI incidence was 4.5%, 10.3%, and 12.2% at 30, 180, and 365 days (1-year), respectively. History of IOI (including retinal vasculitis) and/or retinal occlusion (odds ratio [OR], 5.41; P = 0.0075) and female sex (OR, 1.99; P = 0.0004) were significantly associated with IOI onset. CONCLUSION The 1-year cumulative incidence of IOI in Japanese neovascular age-related macular degeneration patients treated with brolucizumab was 12.2%. History of IOI (including retinal vasculitis) and/or retinal occlusion and female sex were significant risk factors.
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Affiliation(s)
- Satoru Inoda
- Department of Ophthalmology, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan
| | - Hidenori Takahashi
- Department of Ophthalmology, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan
| | - Maiko Maruyama-Inoue
- Department of Ophthalmology and Micro-technology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shoko Ikeda
- Department of Ophthalmology and Micro-technology, Yokohama City University Medical Center, Yokohama, Japan
| | - Tetsuju Sekiryu
- Department of Ophthalmology, Fukushima Medical University, Fukushima-shi, Fukushima, Japan
| | - Kanako Itagaki
- Department of Ophthalmology, Fukushima Medical University, Fukushima-shi, Fukushima, Japan
| | - Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi-shi, Gunma, Japan
| | - Ryo Mukai
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi-shi, Gunma, Japan
| | - Yoshimi Nagai
- Department of Ophthalmology, Kansai Medical University, Hirakata-shi, Osaka, Japan
| | - Masayuki Ohnaka
- Department of Ophthalmology, Kansai Medical University, Hirakata-shi, Osaka, Japan
| | - Sentaro Kusuhara
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Akiko Miki
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Annabelle A Okada
- Department of Ophthalmology, Kyorin University, Mitaka-shi, Tokyo, Japan
| | - Makiko Nakayama
- Department of Ophthalmology, Kyorin University, Mitaka-shi, Tokyo, Japan
| | - Koji M Nishiguchi
- Department of Ophthalmology, Nagoya University, Nagoya-shi, Aichi, Japan
| | - Jun Takeuchi
- Department of Ophthalmology, Nagoya University, Nagoya-shi, Aichi, Japan
| | - Ryusaburo Mori
- Department of Ophthalmology, Nihon University Hospital, Chiyoda-ku, Tokyo, Japan
| | - Koji Tanaka
- Department of Ophthalmology, Nihon University Hospital, Chiyoda-ku, Tokyo, Japan
| | - Shigeru Honda
- Department of Ophthalmology, Osaka Metropolitan University, Osaka-shi, Osaka, Japan
| | - Takeya Kohno
- Department of Ophthalmology, Osaka Metropolitan University, Osaka-shi, Osaka, Japan
| | - Hideki Koizumi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Yasunori Miyara
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Yuji Inoue
- Department of Ophthalmology, Teikyo University, Itabashi-ku, Tokyo, Japan
- Department of Ophthalmology, Nishikasai Inouye Eye Hospital, Tokyo, Japan
| | - Hiroki Takana
- Department of Ophthalmology, Nishikasai Inouye Eye Hospital, Tokyo, Japan
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women's Medical University, Shinjuku-ku, Japan ; and
| | - Ichiro Maruko
- Department of Ophthalmology, Tokyo Women's Medical University, Shinjuku-ku, Japan ; and
| | - Atsushi Hayashi
- Department of Ophthalmology, University of Toyama, Toyama-shi, Toyama, Japan
| | | | - Yasuo Yanagi
- Department of Ophthalmology and Micro-technology, Yokohama City University Medical Center, Yokohama, Japan
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14
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Lanzetta P, Korobelnik JF, Heier JS, Leal S, Holz FG, Clark WL, Eichenbaum D, Iida T, Xiaodong S, Berliner AJ, Schulze A, Schmelter T, Schmidt-Ott U, Zhang X, Vitti R, Chu KW, Reed K, Rao R, Bhore R, Cheng Y, Sun W, Hirshberg B, Yancopoulos GD, Wong TY. Intravitreal aflibercept 8 mg in neovascular age-related macular degeneration (PULSAR): 48-week results from a randomised, double-masked, non-inferiority, phase 3 trial. Lancet 2024; 403:1141-1152. [PMID: 38461841 DOI: 10.1016/s0140-6736(24)00063-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Intravitreal aflibercept 8 mg could improve treatment outcomes and provide sustained disease control in patients with neovascular age-related macular degeneration (nAMD), with extended dosing compared with aflibercept 2 mg. METHODS PULSAR is a phase 3, randomised, three-group, double-masked, non-inferiority, 96-week trial conducted across 223 sites worldwide. Adults with nAMD were randomised 1:1:1 to aflibercept 8 mg every 12 weeks (8q12), aflibercept 8 mg every 16 weeks (8q16), or aflibercept 2 mg every 8 weeks (2q8), following three initial monthly doses in all groups. From week 16, patients in the aflibercept 8 mg groups had their dosing interval shortened if pre-specified dose regimen modification criteria denoting disease activity were met. The primary endpoint was change from baseline in best-corrected visual acuity (BCVA) at week 48. All patients with at least one dose of study treatment were included in the efficacy and safety analyses. This trial is registered with ClinicalTrials.gov (NCT04423718) and is ongoing. FINDINGS Of 1011 patients randomised to aflibercept 8q12 (n=336), 8q16 (n=338), or 2q8 (n=337) between Aug 11, 2020, and July 30, 2021, 1009 patients received study treatment (aflibercept 8q12 n=335; aflibercept 8q16 n=338; and aflibercept 2q8 n=336). Aflibercept 8q12 and 8q16 showed non-inferior BCVA gains versus aflibercept 2q8 (mean BCVA change from baseline +6·7 [SD 12·6] and +6·2 [11·7] vs +7·6 [12·2] letters). The least squares mean differences between aflibercept 8q12 versus 2q8 and 8q16 versus 2q8, respectively, were -0·97 (95% CI -2·87 to 0·92) and -1·14 (-2·97 to 0·69) letters (non-inferiority margin at 4 letters). The incidence of ocular adverse events in the study eye was similar across groups (aflibercept 8q12 n=129 [39%]; aflibercept 8q16 n=127 [38%]; and aflibercept 2q8 n=130 [39%]). INTERPRETATION Aflibercept 8 mg showed efficacy and safety with extended dosing intervals, which has the potential to improve the management of patients with nAMD. FUNDING Bayer AG and Regeneron Pharmaceuticals.
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Affiliation(s)
- Paolo Lanzetta
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy; Istituto Europeo di Microchirurgia Oculare-IEMO, Udine, Italy
| | - Jean-François Korobelnik
- Service d'Ophtalmologie, CHU Bordeaux, Bordeaux, France; Bordeaux Population Health Research Center, INSERM, UMR1219, F-33000, University of Bordeaux, Bordeaux, France
| | | | | | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | | | - Tomohiro Iida
- Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | | | | | | | | | | | - Xin Zhang
- Bayer Consumer Care AG, Basel, Switzerland
| | | | - Karen W Chu
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | - Rohini Rao
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Rafia Bhore
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | - Wei Sun
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | | | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Tsinghua Medicine, Tsinghua University, Beijing, China
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15
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Chadoulos N, Dastiridou A, Mitsios A, Tsinopoulos I, Kalogeropoulos C, Androudi S. Laser flare photometry in eyes receiving brolucizumab intravitreal injections for age related macular degeneration. Eur J Ophthalmol 2024:11206721241236917. [PMID: 38449080 DOI: 10.1177/11206721241236917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
PURPOSE To measure aqueous flare levels in treatment naïve eyes suffering from wet age- related macular degeneration (wAMD) treated with intravitreal brolucizumab. METHODS Patients with treatment naïve wAMD in one eye were prospectively enrolled. Flare levels were measured with laser flare photometry at baseline, 1 day and 1 month after each of the 3 monthly injections during the loading phase. RESULTS Twenty-two eyes from 22 patients aged 76.7 ± 6.0 years were enrolled. Flare values were 10.6 ± 3.7 photons/msec at baseline and 12.6 ± 5.8 photons/msec at the last follow up visit, 1 month after the third injection (p = 0.289, repeated measures ANOVA). The mean change in flare after the first injection was 4.2 ± 3.6. photons/msec, 6.6 ± 8.9 photons/msec after the 2nd and 8.6 ± 20.8 photons/msec after the 3rd injection (p = 0.640, repeated measures ANOVA). No patient had clinical signs of intraocular inflammation. CONCLUSIONS Eyes receiving brolucizumab injections for wAMD showed similar flare at baseline, during and 1 month after completion of three-monthly intravitreal injections. There was no evidence of subclinical inflammation during the loading phase of brolucizumab based on laser flare photometry measurements.
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Affiliation(s)
| | - Anna Dastiridou
- Ophthalmology Department, University of Thessaly, Larissa, Greece
| | - Andreas Mitsios
- Ophthalmology Department, University of Thessaly, Larissa, Greece
| | - Ioannis Tsinopoulos
- Ophthalmology Department, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece
| | | | - Sofia Androudi
- Ophthalmology Department, University of Thessaly, Larissa, Greece
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16
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Tomkins-Netzer O, Niederer R, Greenwood J, Fabian ID, Serlin Y, Friedman A, Lightman S. Mechanisms of blood-retinal barrier disruption related to intraocular inflammation and malignancy. Prog Retin Eye Res 2024; 99:101245. [PMID: 38242492 DOI: 10.1016/j.preteyeres.2024.101245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 01/21/2024]
Abstract
Blood-retinal barrier (BRB) disruption is a common accompaniment of intermediate, posterior and panuveitis causing leakage into the retina and macular oedema resulting in vision loss. It is much less common in anterior uveitis or in patients with intraocular lymphoma who may have marked signs of intraocular inflammation. New drugs used for chemotherapy (cytarabine, immune checkpoint inhibitors, BRAF inhibitors, EGFR inhibitors, bispecific anti-EGFR inhibitors, MET receptor inhibitors and Bruton tyrosine kinase inhibitors) can also cause different types of uveitis and BRB disruption. As malignant disease itself can cause uveitis, particularly from breast, lung and gastrointestinal tract cancers, it can be clinically difficult to sort out the cause of BRB disruption. Immunosuppression due to malignant disease and/or chemotherapy can lead to infection which can also cause BRB disruption and intraocular infection. In this paper we address the pathophysiology of BRB disruption related to intraocular inflammation and malignancy, methods for estimating the extent and effect of the disruption and examine why some types of intraocular inflammation and malignancy cause BRB disruption and others do not. Understanding this may help sort and manage these patients, as well as devise future therapeutic approaches.
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Affiliation(s)
- Oren Tomkins-Netzer
- Department of Ophthalmology, Lady Davis Carmel Medical Centre, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Rachael Niederer
- Department of Ophthalmology, Te Whatu Ora, Auckland, New Zealand; Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - John Greenwood
- Institute of Ophthalmology, University College London, London, UK
| | - Ido Didi Fabian
- The Goldschleger Eye Institute, Sheba Medical Centre, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Yonatan Serlin
- Department of Medical Neuroscience and the Brain Repair Centre, Dalhousie University, Faculty of Medicine, Halifax, NS, Canada
| | - Alon Friedman
- Department of Medical Neuroscience and the Brain Repair Centre, Dalhousie University, Faculty of Medicine, Halifax, NS, Canada; Departments of Physiology and Cell Biology, Brain and Cognitive Sciences, Zlotowski Centre for Neuroscience, Ben- Gurion University of the Negev, Beer-Sheva, Israel
| | - Sue Lightman
- Institute of Ophthalmology, University College London, London, UK
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17
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Matsumoto H, Hoshino J, Nakamura K, Akiyama H. One-year results of treat-and-extend regimen with intravitreal faricimab for treatment-naïve neovascular age-related macular degeneration. Jpn J Ophthalmol 2024; 68:83-90. [PMID: 38244172 DOI: 10.1007/s10384-023-01040-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 12/08/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE To evaluate 1-year outcomes of loading phase treatment followed by maintenance therapy using a treat-and-extend (TAE) regimen with intravitreal faricimab for neovascular age-related macular degeneration (nAMD). STUDY DESIGN Retrospective, interventional case series. METHODS We retrospectively studied 40 eyes of 38 consecutive patients with treatment-naïve nAMD, assessing best-corrected visual acuity (BCVA), foveal thickness, central choroidal thickness (CCT), total number of injections over 1 year, and intended injection interval at the last visit. RESULTS Thirty eyes (75.0%) had completed the 1-year intravitreal faricimab treatment. Their BCVA showed significant improvement, with significant reductions in foveal thickness and CCT. The total number of injections during the 1-year treatment period was 6.6 ± 0.7. The intended injection interval at the last visit was 12.7 ± 3.3 weeks. Of the 10 eyes (25.0%) failing to complete the 1-year faricimab treatment, 1 eye developed intraocular inflammation after the loading phase treatment but showed no recurrence of exudative changes, and no further treatment was required. Moreover, 5 eyes switched to intravitreal brolucizumab injection due to persistent exudative changes with an 8-week interval of faricimab injections. The remaining 4 eyes either dropped out or the patient died. CONCLUSIONS A loading phase treatment followed by a TAE regimen with intravitreal faricimab appears to be generally safe and effective for improving visual acuity and ameliorating exudative changes in eyes with nAMD. However, there might be cases in which exudative changes cannot be adequately controlled with injections of faricimab every 8 weeks in the maintenance phase.
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Affiliation(s)
- Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Junki Hoshino
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Kosuke Nakamura
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hideo Akiyama
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Chronopoulos A, Huynh E, Ashurov A, Schutz JS, Jonas JB, Hattenbach LO. Brolucizumab for recalcitrant macular neovascularization in age-related macular degeneration with pigment epithelial detachment. Eur J Ophthalmol 2024; 34:487-496. [PMID: 37461836 DOI: 10.1177/11206721231187663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
PURPOSE To analyze anatomic and functional response to intravitreal brolucizumab in age-related macular degeneration recalcitrant to previous intravitreal anti-VEGF therapies. METHODS In this monocentric, one arm, retrospective study, eyes affected by neovascular age-related macular degeneration (nAMD) resistant to other intravitreally injected anti-vascular endothelial growth factor inhibitors were switched to intravitreal brolucizumab. All patients underwent ophthalmological examinations at baseline and in regular follow-up intervals. Best registered visual acuity (BRVA), Goldmann tonometry, intraocular pressure (IOP), central retinal thickness (CRT) and pigment epithelial detachment (PED) characteristics were analyzed at initiation of anti-VEGF treatment, at treatment switch, and at the end of brolucizumab loading phase. RESULTS The study included 20 eyes of 18 consecutively treated patients (age: 77 ± 6 years). All eyes had macular neovascularization with PED. Previous treatments included intravitreal aflibercept, bevacizumab, and ranibizumab and had not resulted in a significant improvement in BRVA (0.5 ± 0.5 logMAR vs 0.5 ± 0.6 logMAR) or mean CRT (320 ± 60 µm vs 313 ± 83 µm) up to treatment switch to brolucizumab. At the end of the brolucizumab loading phase, there was significant improvement for both BRVA (0.3 ± 0.2 logMAR, P < 0.05) and CRT (264 ± 55 µm, P < 0.05). Under previous anti-VEGF therapy, there was a significant increase/deterioration in both PED area (2.68 mm2 to 5.18 mm2, P < 0.05) and PED volume (0.39 mm3 to 1.07 mm3, P < 0.05); however, both parameters improved after switching to brolucizumab (3.81 mm2 and 0.37 mm3, P < 0.05). CONCLUSION Our results suggest a favourable anatomical and visual response after treatment switch to brolucizumab in patients with nAMD refractory to previous anti-VEGF agents.
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Affiliation(s)
- Argyrios Chronopoulos
- Department of Ophthalmology, Ludwigshafen City Hospital, Ludwigshafen am Rhein, Germany
| | - Elisa Huynh
- Department of Ophthalmology, Ludwigshafen City Hospital, Ludwigshafen am Rhein, Germany
| | - Agharza Ashurov
- Department of Ophthalmology, Ludwigshafen City Hospital, Ludwigshafen am Rhein, Germany
| | - James S Schutz
- Department of Ophthalmology, Ludwigshafen City Hospital, Ludwigshafen am Rhein, Germany
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Lars-Olof Hattenbach
- Department of Ophthalmology, Ludwigshafen City Hospital, Ludwigshafen am Rhein, Germany
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Korobelnik JF, Chaudhary V, Mitchell P, Kang SW, Tadayoni R, Allmeier H, Lee J, Zhang X, Machewitz T, Bailey C. XTEND: Two-Year Results from a Global Observational Study Investigating Proactive Dosing of Intravitreal Aflibercept in Neovascular Age-Related Macular Degeneration. Ophthalmol Ther 2024; 13:725-738. [PMID: 38198053 PMCID: PMC10853145 DOI: 10.1007/s40123-023-00867-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/24/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION XTEND (NCT03939767) is a multicenter, observational, prospective study of patients with treatment-naïve neovascular age-related macular degeneration (nAMD) in routine clinical practice. The study aims to examine treatment outcomes of proactive intravitreal aflibercept (IVT-AFL) treatment regimens (fixed dosing or treat-and-extend) according to local marketing labels. METHODS Study eyes received IVT-AFL injections as per the local label. The mean changes in best-corrected visual acuity (BCVA) and central subfield thickness (CST) from baseline to month (M) 12 and M24 were measured and stratified by baseline factors. Treatment exposure and safety data were evaluated. Statistical analysis was descriptive. RESULTS Overall, 1466 patients from 17 countries were treated. For the overall population, the mean ± standard deviation (SD) age was 78.7 ± 8.5 (range 50-100) years, and 891 patients (60.8%) were female. The mean ± SD baseline BCVA was 54.3 ± 20.3 letters and CST was 374 ± 126 µm. At M12 and M24, mean (95% confidence interval [CI]) BCVA change was + 4.3 (3.4, 5.3) and + 2.3 (1.3, 3.3) letters, respectively. Mean (95% CI) CST was - 106 (- 114, - 99) μm and - 109 (- 117, - 102) μm at M12 and M24, respectively. At M24, 41.5% of patients had a BCVA ≥ 70 letters. Patients received a mean ± SD of 7.7 ± 2.7 injections by M12 and 10.8 ± 5.0 injections by M24 (3.1 injections between M12 and M24). Adverse events were consistent with the known safety profile of IVT-AFL. CONCLUSION The 24-month results indicate that, in routine clinical practice, a proactive IVT-AFL regimen achieves functional improvements in patients with treatment-naïve nAMD. The proportion of patients achieving ≥ 70 letters at M24 increased, and patients with baseline BCVA ≥ 70 letters maintained vision regardless of the followed IVT-AFL label. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03939767. A video abstract is available for this article. Supplementary file2 (MP4 364624 KB).
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Affiliation(s)
- Jean-François Korobelnik
- Service d'Ophtalmologie, CHU Bordeaux, Bordeaux, France.
- University of Bordeaux, INSERM, BPH, UMR1219, Place Amélie Raba Léon, 33000, Bordeaux, France.
| | - Varun Chaudhary
- Hamilton Regional Eye Institute, St. Joseph's Healthcare, Hamilton, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Paul Mitchell
- Westmead Institute for Medical Research-University of Sydney, Sydney, NSW, Australia
| | - Se Woong Kang
- Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Ramin Tadayoni
- Ophthalmology Department, Université Paris Cité, AP-HP, Lariboisière and Saint Louis Hospitals, Paris, France
- Ophthalmology Department, Fondation Adolphe de Rothschild Hospital, 25-29 Rue Manin, Paris, France
| | | | | | - Xin Zhang
- Bayer Consumer Care AG, Basel, Switzerland
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Xiong X, Zhang X, Li X, Huang T. Adverse events associated with brolucizumab: a disproportionality analysis of the FDA adverse event reporting system (FAERS). Expert Opin Drug Saf 2024:1-6. [PMID: 38404234 DOI: 10.1080/14740338.2024.2322712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/28/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND The safety information of brolucizumab primarily comes from clinical trials experience. This study aimed to explore the ocular and systemic adverse events (AEs) associated with brolucizumab among real-world patients through data mining the FDA Adverse Event Reporting System (FAERS) database. METHODS AE reports submitted to the FAERS database between October 2019 and March 2023 were extracted. The reporting odds ratio was used to evaluate AE signals associated with brolucizumab. RESULTS There were 4,380,839 AE reports extracted from the FAERS database, and 3,313 of which were with brolucizumab as primary suspected. A total of 150 ocular AE signals were identified. Ninety-nine were known ocular AEs listed in brolucizumab' label, primarily including vision-related AEs, intraocular infections, and retinal disorders. Fifty-one were unexpected ocular AE signals, including keratic precipitates, retinal perivascular sheathing, dry eye, glaucoma, etc. Meanwhile, several serious systemic AE signals, including arterial thromboembolic events and rhinorrhea, were also identified. CONCLUSIONS Several unexpected ocular and systemic AE signals associated with brolucizumab were identified through data mining of the FAERS database.
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Affiliation(s)
- Xiaomei Xiong
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xiuwen Zhang
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xiaoxia Li
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Taomin Huang
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai, China
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21
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Ehlers JP, Lunasco LM, Yordi S, Cetin H, Le TK, Sarici K, Kaiser PK, Khanani AM, Talcott KE, Hu J, Meng X, Srivastava SK. Compartmental Exudative Dynamics in Neovascular Age-Related Macular Degeneration: Volumetric Outcomes and Impact of Volatility in a Phase III Clinical Trial. Ophthalmol Retina 2024:S2468-6530(24)00079-4. [PMID: 38403242 DOI: 10.1016/j.oret.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 02/12/2024] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE To examine retinal feature dynamics in eyes with neovascular age-related macular degeneration (nAMD) treated with anti-VEGF therapy and the relationship of these features with visual acuity. DESIGN Post hoc analysis of the phase III, randomized, HAWK nAMD clinical trial. PARTICIPANTS Participants randomized to the brolucizumab 6 mg or aflibercept 2 mg arms of the trial. METHODS Spectral-domain OCT scans collected at 4-week intervals were analyzed using an automated machine learning-enhanced segmentation and feature-extraction platform with manual verification. Quantitative volumetric measures of retinal and exudative features were exported at multiple timepoints over 48 weeks. Volatility of exudative features was calculated as the standard deviation of each feature value during the maintenance phase (week 12-48) of treatment. These features were examined for their associations with anatomic and functional outcomes. MAIN OUTCOME MEASURES Longitudinal intraretinal fluid (IRF) and subretinal fluid (SRF) volume, subretinal hyperreflective material (SHRM) volume, ellipsoid zone (EZ) integrity (EZ-retinal pigment epithelium [RPE] volume/thickness), and correlation with best-corrected visual acuity (BCVA). RESULTS Intraretinal fluid, SRF, and SHRM demonstrated significant volumetric reduction from baseline with anti-VEGF therapy (P < 0.001 at each timepoint). Ellipsoid zone integrity measures demonstrated significant improvement from baseline (P < 0.001 at each timepoint). Both EZ integrity and SHRM measures correlated significantly with BCVA at all timepoints (EZ-RPE volume: 0.38 ≤ r ≤ 0.47; EZ-RPE central subfield thickness: 0.22 ≤ r ≤ 0.41; SHRM volume: -0.33 ≤ r ≤ -0.44). After treatment initiation, correlations of IRF and SRF volume with BCVA were weak or nonsignificant. Eyes with lower volatility of IRF, SRF, and SHRM volumes during the maintenance phase showed greater improvements in EZ integrity (all P < 0.01) and greater gains in BCVA (all P < 0.01) at week 48 compared with eyes with higher volatility in those exudative parameters. CONCLUSIONS Quantitative measures of SHRM volume and EZ integrity correlated more strongly with BCVA than retinal fluid volumes during treatment. High volatility of exudative parameters, including SRF, during the maintenance phase of treatment was associated with loss of EZ integrity and BCVA. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Justis P Ehlers
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Leina M Lunasco
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sari Yordi
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hasan Cetin
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Thuy K Le
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kubra Sarici
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Arshad M Khanani
- Sierra Eye Associates, Reno, Nevada; University of Nevada, Reno School of Medicine, Reno, Nevada
| | - Katherine E Talcott
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joanne Hu
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | - Xiangyi Meng
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | - Sunil K Srivastava
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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22
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Tanaka A, Hata M, Tsuchikawa M, Ueda-Arakawa NUA, Tamura H, Miyata M, Takahashi A, Kido A, Muraoka Y, Miyake M, Ooto S, Tsujikawa A. Short-Term Outcomes of 3 Monthly intravitreal Faricimab On Different Subtypes of Neovascular Age-Related Macular Degeneration. Clin Ophthalmol 2024; 18:507-516. [PMID: 38405104 PMCID: PMC10893793 DOI: 10.2147/opth.s448507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/15/2024] [Indexed: 02/27/2024] Open
Abstract
Purpose To evaluate the efficacy and safety of faricimab injections for treatment-naïve neovascular age-related macular degeneration (nvAMD) patients, including subtypes and pachychoroid phenotypes, and identify predictive factors for visual outcomes. Methods nvAMD patients were prospectively recruited, receiving three monthly faricimab (6 mg) injections. Best-corrected visual acuity (BCVA) two months after the last injection (month 4) was compared between subtypes, and between pachychoroid neovasculopathy (PNV) and non-PNV eyes. Regression analysis determined factors influencing month 4 BCVA. Results The study involved 23 patients (12 typical AMD [tAMD], 10 polypoidal choroidal vasculopathy [PCV], 1 retinal angiomatous proliferation [RAP]). Eleven exhibited PNV phenotype. Significant BCVA (P = 4.9 × 10-4) and central retinal thickness (CRT) (P = 1.3 × 10-5) improvements were observed post-faricimab treatment. The therapy demonstrated favourable results for both tAMD and PCV eyes, and non-PNV and PNV eyes. Faricimab achieved dry macula in 77.3% of eyes, with subretinal fluid resolution in most cases, although intraretinal fluid (IRF) often persisted. Multivariable analysis identified external limiting membrane (ELM) presence and IRF as BCVA contributors at month 4. Conclusion Faricimab demonstrated significant effectiveness and safety in treatment-naïve nvAMD patients, particularly for PCV and PNV eyes. ELM presence and IRF is predictive of visual outcomes.
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Affiliation(s)
- Asako Tanaka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masayuki Hata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Memiri Tsuchikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Hiroshi Tamura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Manabu Miyata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ayako Takahashi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ai Kido
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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23
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Khanani AM, Kotecha A, Chang A, Chen SJ, Chen Y, Guymer R, Heier JS, Holz FG, Iida T, Ives JA, Lim JI, Lin H, Michels S, Quezada Ruiz C, Schmidt-Erfurth U, Silverman D, Singh R, Swaminathan B, Willis JR, Tadayoni R. TENAYA and LUCERNE: Two-Year Results from the Phase 3 Neovascular Age-Related Macular Degeneration Trials of Faricimab with Treat-and-Extend Dosing in Year 2. Ophthalmology 2024:S0161-6420(24)00134-9. [PMID: 38382813 DOI: 10.1016/j.ophtha.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024] Open
Abstract
PURPOSE To evaluate 2-year efficacy, durability, and safety of the bispecific antibody faricimab, which inhibits both angiopoietin-2 and VEGF-A. DESIGN TENAYA (ClinicalTrials.gov identifier, NCT03823287) and LUCERNE (ClinicalTrials.gov identifier, NCT03823300) were identically designed, randomized, double-masked, active comparator-controlled phase 3 noninferiority trials. PARTICIPANTS Treatment-naive patients with neovascular age-related macular degeneration (nAMD) 50 years of age or older. METHODS Patients were randomized (1:1) to intravitreal faricimab 6.0 mg up to every 16 weeks (Q16W) or aflibercept 2.0 mg every 8 weeks (Q8W). Faricimab fixed dosing based on protocol-defined disease activity at weeks 20 and 24 up to week 60, followed up to week 108 by a treat-and-extend personalized treatment interval regimen. MAIN OUTCOME MEASURES Efficacy analyses included change in best-corrected visual acuity (BCVA) from baseline at 2 years (averaged over weeks 104, 108, and 112) and proportion of patients receiving Q16W, every 12 weeks (Q12W), and Q8W dosing at week 112 in the intention-to-treat population. Safety analyses included ocular adverse events (AEs) in the study eye through study end at week 112. RESULTS Of 1326 patients treated across TENAYA/LUCERNE, 1113 (83.9%) completed treatment (n = 555 faricimab; n = 558 aflibercept). The BCVA change from baseline at 2 years was comparable between faricimab and aflibercept groups in TENAYA (adjusted mean change, +3.7 letters [95% confidence interval (CI), +2.1 to +5.4] and +3.3 letters [95% CI, +1.7 to +4.9], respectively; mean difference, +0.4 letters [95% CI, -1.9 to +2.8]) and LUCERNE (adjusted mean change, +5.0 letters [95% CI, +3.4 to +6.6] and +5.2 letters [95% CI, +3.6 to +6.8], respectively; mean difference, -0.2 letters [95% CI, -2.4 to +2.1]). At week 112 in TENAYA and LUCERNE, 59.0% and 66.9%, respectively, achieved Q16W faricimab dosing, increasing from year 1, and 74.1% and 81.2%, achieved Q12W or longer dosing. Ocular AEs in the study eye were comparable between faricimab and aflibercept groups in TENAYA (55.0% and 56.5% of patients, respectively) and LUCERNE (52.9% and 47.5% of patients, respectively) through week 112. CONCLUSIONS Treat-and-extend faricimab treatment based on nAMD disease activity maintained vision gains through year 2, with most patients achieving extended dosing intervals. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Arshad M Khanani
- Sierra Eye Associates and the University of Nevada, Reno, School of Medicine, Reno, Nevada.
| | - Aachal Kotecha
- Roche Products, Ltd., Welwyn Garden City, United Kingdom
| | - Andrew Chang
- Sydney Retina Clinic, Sydney Eye Hospital, University of Sydney, and Discipline of Surgery, University of New South Wales, Sydney, Australia
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Beijing, China
| | - Robyn Guymer
- Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, and Department of Surgery, University of Melbourne, Melbourne, Australia
| | | | - Frank G Holz
- Department of Ophthalmology and GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | - Jane A Ives
- Roche Products, Ltd., Welwyn Garden City, United Kingdom
| | - Jennifer I Lim
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Hugh Lin
- Genentech, Inc., South San Francisco, California
| | - Stephan Michels
- Eye Clinic Zurich West, Zurich, Switzerland; Department of Ophthalmology, University of Zurich, Zurich, Switzerland
| | | | - Ursula Schmidt-Erfurth
- Department of Ophthalmology, Vienna Reading Center and Ophthalmic Image Analysis Group (OPTIMA), Medical University of Vienna, Vienna, Austria
| | | | | | | | | | - Ramin Tadayoni
- Université Paris Cité, AP-HP, Lariboisière, Saint Louis, Fondation Adolphe de Rothschild Hospitals, Paris, France
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Kamao H, Mitsui E, Date Y, Goto K, Mizukawa K, Miki A. The Effect of a Loading Dose Regimen in the Switch to Brolucizumab for Patients with Aflibercept-Resistant nAMD. J Ophthalmol 2024; 2024:3673930. [PMID: 38322501 PMCID: PMC10846919 DOI: 10.1155/2024/3673930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/26/2023] [Accepted: 01/17/2024] [Indexed: 02/08/2024] Open
Abstract
Purpose To evaluate the one-year outcomes of switching to brolucizumab with and without a loading dose regimen (three monthly injections) in eyes with aflibercept-resistant neovascular age-related macular degeneration (nAMD). Methods We retrospectively studied nAMD patients who had retinal exudate under bimonthly injections of aflibercept and were switched to brolucizumab from aflibercept. Patients were grouped into intravitreal brolucizumab injection (IVBr) with a loading dose regimen (loading group) and without a loading dose regimen (nonloading group). We assessed the best-corrected visual acuity (BCVA), central retinal thickness (CRT) at the fovea, subfoveal choroidal thickness (SFCT), IVBr status (number of injections and last injection interval), and retinal exudate status on optical coherence tomography. Results Overall, 52 eyes received ≥1 IVBr; 26 eyes received ≥3 IVBr with 12-month follow-up. A total of 13 eyes in the loading group and 13 eyes in the nonloading group were reviewed. One year after switching, BCVA changed from 0.28 ± 0.25 to 0.19 ± 0.28 in the loading group (P=0.28) and from 0.25 ± 0.20 to 0.23 ± 0.25 in the nonloading group (P=0.92). The mean CRT decreased from 263.6 ± 40.7 µm to 221.7 ± 54.6 µm in the loading group (P=0.03), while it only changed from 244.9 ± 77.2 µm to 221.0 ± 78.7 µm in the nonloading group (P=0.26). Both the loading and nonloading groups achieved 69% dry macula. The number of injections received was significantly higher in the loading group (7.6 ± 0.6 vs. 6.8 ± 0.4, P < 0.001). Two patients (4.2%) developed intraocular inflammation. Conclusion Switching to brolucizumab from aflibercept for eyes with nAMD with resistance to bimonthly injections of aflibercept is a valuable treatment option with and without the loading regimen. This trial is registered with UMIN000023676.
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Affiliation(s)
- Hiroyuki Kamao
- Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0114, Japan
| | - Erika Mitsui
- Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0114, Japan
| | - Yuto Date
- Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0114, Japan
| | - Katsutoshi Goto
- Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0114, Japan
| | - Kenichi Mizukawa
- Shirai Eye Hospital, 1339 Takasecho Kamitakase, Mitoyo, Kagawa 767-0001, Japan
| | - Atsushi Miki
- Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0114, Japan
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25
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Hara C, Suzue M, Fujimoto S, Fukushima Y, Sayanagi K, Nishida K, Maruyama K, Sato S, Nishida K. Comparison of Loading Dose between Aflibercept and Faricimab for Neovascular Age-Related Macular Degeneration. J Clin Med 2024; 13:385. [PMID: 38256517 PMCID: PMC10816479 DOI: 10.3390/jcm13020385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Recently, faricimab was approved as the new drug for neovascular age-related macular degeneration (nAMD). We lack the knowledge to choose between the existing drug and this new drug to use for treatment-naïve nAMD cases. In this study, we compared the functional and morphologic effects in loading dose between patients with treatment-naïve nAMD treated with either intravitreal aflibercept (IVA) or intravitreal faricimab (IVF) injection in a clinical setting. METHOD This retrospective study included 30 eyes of 28 patients who started treatment with IVA between June and September 2022 and 30 eyes of 29 patients who were administered IVF between October 2022 and March 2023. All patients received three monthly IVA or IVF. The best corrected visual acuity (BCVA), central retinal thickness (CRT), and the proportion of eyes with residual exudative change at baseline and 1,2, and 3 months after initial treatment were compared between the groups. RESULTS The mean BCVA significantly improved from pre-treatment after the loading dose in the IVA group (0.46 ± 0.46-0.36 ± 0.37, p = 0.0047) but not in the IVF group (0.46 ± 0.41-0.44 ± 0.45, p = 0.60). The mean CRT significantly improved in both groups. The proportion of eyes with residual exudative change was greater in the IVF group than in the IVA group 2 months after the first treatment (p = 0.026). The analysis of cases that achieved complete resolution of exudative changes after the loading dose showed that the IVA group had a significant improvement in the BCVA, whereas the IVF group did not (p = 0.0047 and 0.20, respectively). CONCLUSIONS Although both IVA and IVF significantly improved CRT, the BCVA improved significantly in the IVA group but not in the IVF group.
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Affiliation(s)
- Chikako Hara
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan; (M.S.); (S.F.); (Y.F.); (K.S.); (K.N.); (K.M.); (S.S.); (K.N.)
| | - Masaki Suzue
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan; (M.S.); (S.F.); (Y.F.); (K.S.); (K.N.); (K.M.); (S.S.); (K.N.)
| | - Satoko Fujimoto
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan; (M.S.); (S.F.); (Y.F.); (K.S.); (K.N.); (K.M.); (S.S.); (K.N.)
| | - Yoko Fukushima
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan; (M.S.); (S.F.); (Y.F.); (K.S.); (K.N.); (K.M.); (S.S.); (K.N.)
| | - Kaori Sayanagi
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan; (M.S.); (S.F.); (Y.F.); (K.S.); (K.N.); (K.M.); (S.S.); (K.N.)
| | - Kentaro Nishida
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan; (M.S.); (S.F.); (Y.F.); (K.S.); (K.N.); (K.M.); (S.S.); (K.N.)
| | - Kazuichi Maruyama
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan; (M.S.); (S.F.); (Y.F.); (K.S.); (K.N.); (K.M.); (S.S.); (K.N.)
- Department of Vision Informatics, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan
| | - Shigeru Sato
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan; (M.S.); (S.F.); (Y.F.); (K.S.); (K.N.); (K.M.); (S.S.); (K.N.)
| | - Kohji Nishida
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan; (M.S.); (S.F.); (Y.F.); (K.S.); (K.N.); (K.M.); (S.S.); (K.N.)
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Suita 565-0871, Osaka, Japan
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Narnaware SH, Bansal A, Bawankule PK, Raje D. Real-world experience of brolucizumab in nAMD. Indian J Ophthalmol 2024; 72:S27-S32. [PMID: 38131538 PMCID: PMC10833170 DOI: 10.4103/ijo.ijo_792_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To evaluate real-world outcomes with neovascular age-related macular degeneration (nAMD) in relation to anatomical success, visual outcomes, and safety of intravitreal brolucizumab (IVBr) injection at 1.5 years. METHODS Prospective, randomized, single-center study between December 2020 and December 2022 that included 71 eyes of 62 patients with nAMD, who received IVBr. Patients were divided into three groups, i.e., naïve choroidal neovascular membrane (CNVM), switched therapy (st) CNVM, and st polypoidal choroidal vasculopathy (stPCV). They were subdivided into dry, minimal fluid (fluid <50 microns)/pigment epithelial detachment (PED) and persistent fluid (fluid >100 microns)/PED subgroups depending upon the fluid level at the end of 1.5 years. Best-corrected visual acuity (BCVA), central macular thickness (CMT), status of fluid, and number of injections at 1.5 years were evaluated. From the beginning, patients were treated on pro re nata (PRN) basis. RESULTS Of the 71 eyes, 27 eyes (38%) were naïve CNVM, 35 eyes (49.3%) were stCNVM, and 9 (12.7%) were stPCV cases. Significant vision improvement after 1.5 years was seen in the stCNVM category (P = 0.001), while CMT reduction was significant in all three groups (P < 0.05). The mean number of injections required in naïve CNVM and stCNVM groups was significantly less as compared to the stPCV group (P = 0.017). Further, vision improvement was significant in the "Minimal fluid" subgroup (P = 0.002), while the CMT improvement was significant in the "Minimal fluid" and "Dry" subgroups each with P < 0.0001. No ocular/systemic adverse events including intraocular inflammation (IOI) were noted. CONCLUSION In a real-world scenario, with 203 procedures and 1.5-year follow-up, brolucizumab is found to be efficacious and safe with the need for a lesser number of injections and more interval-free period in the management of naïve CNVM, stCNVM, and stPCV patients.
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Affiliation(s)
- Shilpi H Narnaware
- Vitreo-retina Surgeon and ROP Specialist, Sarakshi Netralaya, Nagpur, Maharashtra, India
| | - Anju Bansal
- Department of Retina, Sarakshi Netralaya, Nagpur, Maharashtra, India
| | | | - Dhananjay Raje
- Head, Data Analysis Group, MDS Bio-analytics Pvt. Ltd. Nagpur, Maharashtra, India
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Witkin AJ, Jaffe GJ, Srivastava SK, Davis JL, Kim JE. Retinal Vasculitis After Intravitreal Pegcetacoplan: Report From the ASRS Research and Safety in Therapeutics (ReST) Committee. JOURNAL OF VITREORETINAL DISEASES 2024; 8:9-20. [PMID: 38223782 PMCID: PMC10786078 DOI: 10.1177/24741264231220224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Purpose: To analyze post-marketing cases of retinal vasculitis after intravitreal pegcetacoplan. Methods: The American Society of Retina Specialists (ASRS) Research and Safety in Therapeutics (ReST) Committee as well as an expert panel performed a retrospective review of cases of retinal vasculitis reported to the ASRS. Clinical and imaging characteristics were reviewed for evidence of retinal vasculitis and analyzed. Results: Fourteen eyes of 13 patients were confirmed to have retinal vasculitis by review of imaging studies. All cases occurred after the first pegcetacoplan injection. Occlusive retinal vasculopathy was confirmed in 11 eyes (79%). Patients presented a median of 10.5 days (range, 8-23 days) after pegcetacoplan injection. All eyes had anterior chamber inflammation, and 12 eyes (86%) had vitritis. Vasculopathy involved retinal veins (100%) more than arteries (73%), and 12 eyes (86%) had retinal hemorrhages. The median visual acuity (VA) was 20/60 (range, 20/30-5/200) at baseline, 20/300 (range, 20/100-no light perception [NLP]) at vasculitis presentation, and 20/200 (range 20/70-NLP) at the last follow-up. Eight eyes (57%) had more than a 3-line decrease in VA, and 6 eyes (43%) had more than a 6-line decrease in VA from baseline to the final follow-up, including 2 eyes that were enucleated. Six eyes (43%) developed signs of anterior segment neovascularization. Conclusions: There is currently no known etiology for vasculitis in this series. Optimum treatment strategies remain unknown. Infectious etiologies should be considered, and corticosteroid treatments may hasten resolution of inflammatory findings. Continued treatment of affected patients with pegcetacoplan should be avoided.
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Affiliation(s)
| | | | | | - Janet L. Davis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Judy E. Kim
- UT Southwestern Medical Center, Dallas, TX, USA
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Sarraf D, Khanani AM, Sadda SR, Chang A, Wong DT, Kempf AS, Saffar I, Tang S, Tadayoni R. PIGMENT EPITHELIAL DETACHMENT THICKNESS AND VARIABILITY AFFECTS VISUAL OUTCOMES IN PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION. Retina 2024; 44:10-19. [PMID: 37824807 DOI: 10.1097/iae.0000000000003935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
PURPOSE To evaluate the impact of pigment epithelial detachment (PED) thickness (i.e., height) and thickness variability on best-corrected visual acuity outcomes in patients with neovascular age-related macular degeneration in the Phase 3 HAWK and HARRIER trials. METHODS Optical coherence tomography images from the pooled brolucizumab 6 mg and aflibercept 2 mg arms were analyzed for the maximum PED thickness across the macula at baseline through to week 96. Best-corrected visual acuity outcomes were compared in patients with different PED thickness and variability cut-off thresholds. RESULTS Greater PED thickness at baseline or at week 12 was associated with lower mean best-corrected visual acuity gain from baseline to week 96 (baseline PED ≥200 µ m: +4.6 letters; <200 µ m: +7.0 letters; week 12 PED ≥100 µ m: +5.6 letters; <100 µ m: +6.6 letters). Eyes with the largest PED thickness variability from week 12 through week 96 gained fewer letters from baseline at week 96 (≥33 µ m: +3.3 letters; <9 µ m: +6.2 letters). Furthermore, increased PED thickness at week 48 was associated with higher prevalence of intraretinal and subretinal fluid. CONCLUSION In this treatment-agnostic analysis, greater PED thickness and PED thickness variability were associated with poorer visual outcomes in patients with neovascular age-related macular degeneration and greater neovascular activity.
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Affiliation(s)
- David Sarraf
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - Arshad M Khanani
- Sierra Eye Associates, Reno, Nevada
- Reno School of Medicine, University of Nevada, Reno, Nevada
| | - SriniVas R Sadda
- Doheny Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - Andrew Chang
- Sydney Retina Clinic, Sydney Eye Hospital, Sydney University, Camperdown, NSW, Australia
| | - David T Wong
- Unity Health Toronto-St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Ramin Tadayoni
- Department of Ophthalmology, Université Paris Cité, AP-HP, Lariboisière, Saint Louis, Missouri
- Rothschild Foundation Hospitals, Paris, France
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Pece A, Fossataro F, Maione G, Liuzzi R. Structural and clinical changes in previously treated type 1 macular neovascularization in non-responder AMD eyes switched to brolucizumab. Eur J Ophthalmol 2024; 34:245-251. [PMID: 37150939 DOI: 10.1177/11206721231174491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
PURPOSE To examine structural and clinical changes in previously treated type 1 macular neovascularization (MNV) in non-responder age-related macular degeneration (nAMD) eyes switched to brolucizumab. Subretinal hyper-reflective material (SHRM), intraretinal (IRF) and subretinal fluid (SRF) presence, fibrovascular-pigment epithelium detachment (PED) height and central macular thickness (CMT) variation were analyzed using optical coherence tomography (OCT). METHODS In this prospective study all patients underwent a complete ophthalmological evaluation including structural OCT at baseline (T0), one month (T1), three (T2), four (T3) and six months after switching to brolucizumab treatment (T4). Non-responder criterion was the persistence of IRF and SRF. Moreover, CMT and BCVA had shown worsening or no improvement before switching to brolucizumab. Clinical function and structural activity biomarkers were measured at each visit and changes were analyzed. P value <0.05 was considered statistically significant. RESULTS Twenty eyes of twenty patients were enrolled. All the structural variables examined during the follow-up showed significant reductions. Decreases in IRF, SRF and PED were already significant at T1 (p < 0.05). SHRM was significantly reduced at T2 (p < 0.05). Structural biomarkers were absent at T3. At T4, all biomarkers remained stable while SHRM was no longer detectable in 18 patients. Changes in visual acuity from baseline to T4 were not significant. CONCLUSION This short-term experience highlights that brolucizumab might be considered an effective treatment option in nAMD with type 1 MNV, as it can promote a reduction of structural activity biomarkers.
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Affiliation(s)
- Alfredo Pece
- Department of Ophthalmology, Melegnano Hospital, Milan, Italy
| | | | - Giulio Maione
- Department of Ophthalmology, Melegnano Hospital, Milan, Italy
| | - Raffaele Liuzzi
- Institute of Biostructure and Bioimaging, National Research Council of Italy, Napoli, Italy
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Singh RP, Barakat MR, Ip MS, Wykoff CC, Eichenbaum DA, Joshi S, Warrow D, Sheth VS, Stefanickova J, Kim YS, He F, Cho GE, Wang Y, Emanuelli A. Efficacy and Safety of Brolucizumab for Diabetic Macular Edema: The KINGFISHER Randomized Clinical Trial. JAMA Ophthalmol 2023; 141:1152-1160. [PMID: 37971723 DOI: 10.1001/jamaophthalmol.2023.5248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Importance Despite the effectiveness of existing anti-vascular endothelial growth factor (VEGF) therapies, a need remains for further treatment options to improve response rates and/or reduce injection or monitoring frequency in patients with diabetic macular edema (DME). Objective To evaluate the efficacy and safety of brolucizumab vs aflibercept dosed every 4 weeks in participants with DME. Design, Participants, and Setting This 52-week, double-masked, phase 3 randomized clinical trial included treatment-naive adults and adults who had previously received anti-VEGF therapy. Data were collected from September 2019 to March 2020, and data were analyzed from April 2020 to February 2021. Intervention Brolucizumab, 6 mg, intravitreal injection every 4 weeks or aflibercept, 2 mg, intravitreal injection every 4 weeks. Main Outcomes and Measures Participants were randomized 2:1 to brolucizumab, 6 mg, or aflibercept, 2 mg. The primary end point was change from baseline in best-corrected visual acuity at week 52. Secondary end points were the proportion of participants with a 2-step improvement or greater from baseline in Diabetic Retinopathy Severity Scale score, the proportion of eyes with absence of both subretinal fluid and intraretinal fluid, change from baseline in central subfield thickness, and safety at week 52. Results A total of 517 participants were randomized to brolucizumab (n = 346) or aflibercept (n = 171); 299 (57.8%) were male, and the mean (SD) age was 60.7 (10.2) years. Brolucizumab was noninferior to aflibercept in best-corrected visual acuity (Early Treatment Diabetic Retinopathy Study letter score) change from baseline at week 52 (brolucizumab, 12.2-letter improvement; aflibercept, 11.0-letter improvement; difference, 1.1; 95% CI, -0.6 to 2.9; noninferiority margin, 4; P < .001). Brolucizumab was superior to aflibercept for the proportion of eyes without subretinal and intraretinal fluid (brolucizumab, 144 of 346 [41.6%]; aflibercept, 38 of 171 [22.2%]; difference, 20.0%; 95% CI, 12.5to 28.6; P < .001) and mean central subfield thickness change from baseline at week 52 (brolucizumab, -237.8 μm; aflibercept, -196.5 μm; difference, -41.4; 95% CI, -58.9 to -23.8; P < .001). Incidence of intraocular inflammation was 4.0% (14 of 346) in the brolucizumab arm and 2.9% (5 of 171) in the aflibercept arm, incidence of retinal vasculitis was 0.9% (3 of 346) and 0.6% (1 of 171), respectively, and incidence of retinal vascular occlusion was 0.3% (1 of 346) and 0.6% (1 of 171). One participant in the brolucizumab arm had retinal artery occlusion. Conclusions and Relevance In these study participants with DME, no clinically meaningful differences in visual outcomes were noted between the brolucizumab and aflibercept arms; some superior anatomic improvements were noted in the brolucizumab arm. No new safety concerns were identified. Trial Registration ClinicalTrials.gov Identifier: NCT03917472.
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Affiliation(s)
- Rishi P Singh
- Cleveland Clinic Martin Hospitals, Cleveland Clinic Florida, Stuart
| | - Mark R Barakat
- Retinal Consultants of Arizona, Phoenix
- University of Arizona College of Medicine, Phoenix
| | - Michael S Ip
- Doheny Eye Institute, UCLA Department of Ophthalmology, University of California, Los Angeles
| | | | - David A Eichenbaum
- Retina Vitreous Associates of Florida, St Petersburg
- Morsani College of Medicine, University of South Florida, Tampa
| | | | - David Warrow
- Cumberland Valley Retina Consultants, Hagerstown, Pennsylvania
| | - Veeral S Sheth
- University Retina and Macula Associates, Chicago, Illinois
| | - Jana Stefanickova
- Department of Ophthalmology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | | | - Fanyin He
- Beijing Novartis Pharma, Beijing, China
| | - Ga Eun Cho
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | | | - Andrés Emanuelli
- Department of Ophthalmology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
- Emanuelli Research and Development Center, Arecibo, Puerto Rico
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Taketani M, Arakawa H, Maruko I, Hasegawa T, Iida T. Characteristics of Eyes With Neovascular Age-Related Macular Degeneration Requiring Frequent Anti-vascular Endothelial Growth Factor Injections. Cureus 2023; 15:e50817. [PMID: 38249251 PMCID: PMC10797311 DOI: 10.7759/cureus.50817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/23/2024] Open
Abstract
Objective In this study, we aimed to determine the characteristics of neovascular age-related macular degeneration (AMD) patients requiring frequent anti-vascular endothelial growth factor (VEGF) therapy. Methods This was a retrospective observational study involving the review of 32 eyes of 31 patients (25 men and six women, mean age: 74.3 years) treated with anti-VEGF injections for less than eight weeks and at least one year of follow-up. The subtype of macular neovascularization (MNV), follow-up duration, number of injections, visual acuity, and exudative changes during the study period were evaluated. Results Twenty-nine eyes (90.6%) had MNV under the retinal pigment epithelium (RPE), including 11 eyes with type 1 MNV and 18 eyes with polypoidal choroidal vasculopathy (PCV). Only three eyes had type 2 MNV (9.4%) above the RPE. The mean follow-up period was 28.7 ± 16.5 months, and the mean number of injections was 21.5 ± 11.8. The mean visual acuity [logarithm of the minimum angle of resolution (logMAR) units] was 0.19 ± 0.23 at the initial visit to our hospital, which decreased non-significantly to 0.24 ± 0.4 at the final visit (p=0.63). The exudation in four eyes (two with type 1 MNV and two with PCV) never resolved. The exudation remained in 27 eyes (84%) even after every four weeks of treatment, and it was present in five eyes (16%) in the treatment interval of eight weeks. Conclusions In the eyes receiving frequent anti-VEGF injections, the sub-RPE MNV might have affected the response to the treatment. Although patients requiring frequent anti-VEGF therapy did not have a significant decrease in their visual acuity, 84% of the eyes had exudations even with monthly injections.
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Affiliation(s)
| | - Hisaya Arakawa
- Ophthalmology, Tokyo Women's Medical University, Tokyo, JPN
| | - Ichiro Maruko
- Ophthalmology, Tokyo Women's Medical University, Tokyo, JPN
| | - Taiji Hasegawa
- Ophthalmology, Tokyo Women's Medical University, Tokyo, JPN
| | - Tomohiro Iida
- Ophthalmology, Tokyo Women's Medical University, Tokyo, JPN
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Carosielli M, Carnevali A, Fallico M, Pirozzi E, Chiosi F, Chronopoulos A, Cucciniello P, Affatato M, Rapino G, dell'Omo R. Intravitreal Brolucizumab for Pachychoroid Neovasculopathy Associated With Chronic Central Serous Chorioretinopathy. Transl Vis Sci Technol 2023; 12:17. [PMID: 38112497 PMCID: PMC10732086 DOI: 10.1167/tvst.12.12.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023] Open
Abstract
Purpose To evaluate the anatomical and functional outcomes of intravitreal brolucizumab in eyes with chronic central serous chorioretinopathy complicated by pachychoroid neovasculopathy. Methods Retrospective analysis of 34 eyes treated with intravitreal brolucizumab. Twenty-five eyes (73.5%) had been treated with other anti-vascular endothelial growth factor agents before switching to brolucizumab, whereas nine eyes were naïve. Outcome measures included the change of central foveal thickness and subfoveal choroidal thickness, evaluation of sub/intraretinal fluid on optical coherence tomography, and change in best-corrected visual acuity. Results Before starting brolucizumab, 23 eyes showed subretinal fluid, 8 both subretinal and intraretinal fluid, and 3 intraretinal fluid only. At the last visit, 22 eyes (64.7%) showed complete reabsorption of both intraretinal and subretinal fluid, whereas subretinal fluid was still present in 8 eyes (23.5%), and both intraretinal and subretinal fluid in 4 eyes (11.8%). The mean number of brolucizumab injections required to achieve complete fluid reabsorption was 2.8 ± 1.8. central foveal thickness decreased from 317.8 ± 109.3 µm to 239.8 ± 74.8 µm (P = 0.0005) and subfoveal choroidal thickness decreased from 399.3 ± 86.2 µm to 355.5 ± 92.7 µm at the end of the follow-up period (P = 0.0008). The mean logarithm of the minimum angle of resolution best-corrected visual acuity improved from 0.4 ± 0.2 to 0.3 ± 0.2 at 1 month after the first injection and remained stable at the same values at the end of the follow-up period (P = 0.04). Conclusions Intravitreal brolucizumab is effective for the treatment of naïve and recalcitrant pachychoroid neovasculopathy. Translational Relevance Intravitreal brolucizumab may represent an option in patients with pachychoroid neovasculopathy complicating chronic central serous chorioretinopathy.
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Affiliation(s)
- Marianna Carosielli
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - Adriano Carnevali
- Department of Ophthalmology, University Magna Græcia, Catanzaro, Italy
| | - Matteo Fallico
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Enza Pirozzi
- Department of Ophthalmology, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Flavia Chiosi
- Department of Ophthalmology, Azienda Ospedaliera dei Colli-Ospedale Monaldi, Naples, Italy
| | | | - Pasquale Cucciniello
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - Marzia Affatato
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - Giuseppe Rapino
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - Roberto dell'Omo
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - on behalf of the BROCS study group, BROCS (BROlucizumab for the treatment of Central Serous chorioretinopathy) study group†
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
- Department of Ophthalmology, University Magna Græcia, Catanzaro, Italy
- Department of Ophthalmology, University of Catania, Catania, Italy
- Department of Ophthalmology, Santa Croce e Carle Hospital, Cuneo, Italy
- Department of Ophthalmology, Azienda Ospedaliera dei Colli-Ospedale Monaldi, Naples, Italy
- Department of Ophthalmology, Ludwigshafen Hospital, Ludwigshafen am Rhein, Germany
- Department of Experimental Biomedicine and Cnilical Neuroscience, Ophthalmology Section, University of Palermo, Palermo, Italy
- Eye Clinic, Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples Federico II, Naples, Italy
- Eye Unit, Department of Medicine Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Italy
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Jiao X, Peng X, Jin X, Liu N, Yu Y, Liu R, Li Z. Nano-composite system of traditional Chinese medicine for ocular applications: molecular docking and three-dimensional modeling insight for intelligent drug evaluation. Drug Deliv Transl Res 2023; 13:3132-3144. [PMID: 37355484 DOI: 10.1007/s13346-023-01376-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 06/26/2023]
Abstract
The absorption of drugs was impeded in the posterior part of the eye due to the special structure. In addition, it was crucial to comprehend transport laws of molecules in ocular drug delivery for designing effective strategies. However, the current quality evaluation methods of the eye were backward and lack of dynamic monitoring of drug processes in vivo. Herein, nano-drug delivery system and three-dimensional (3D) model were combined to overcome the problems of low bioavailability and diffusion law. The model drugs were screened by molecular docking. The flexible nano-liposome (FNL) and temperature-sensitive gel (TSG) composite formulation was characterized through comprehensive evaluation. COMSOL software was utilized to build 3D eyeball to predict the bioavailability of drugs. The size of the preparation was about 98.34 nm which is relatively optimal for the enhanced permeability of the eyes. The formulation showed a stronger safety and non-irritant. The pharmacokinetics results of aqueous humor showed that the AUC of two drugs in this system increased by 3.79 and 3.94 times, respectively. The results of 3D calculation model proved that the concentrations of drugs reaching the retina were 1.90×10-5 mol/m3 and 6.37×10-6 mol/m3. In conclusion, the FNL-TSG markedly improved the bioavailability of multiple components in the eye. More importantly, a simplified 3D model was developed to preliminarily forecast the bioavailability of the retina after drug infusion, providing technical support for the accurate evaluation of ocular drug delivery. It provided new pattern for the development of intelligent versatile ophthalmic preparations.
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Affiliation(s)
- Xinyi Jiao
- State Key Laboratory of Component‑Based Chinese Medicine, College of Pharmaceutical Engineering of Traditional Chinese Medicine, Haihe Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Xingru Peng
- State Key Laboratory of Component‑Based Chinese Medicine, College of Pharmaceutical Engineering of Traditional Chinese Medicine, Haihe Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Xin Jin
- Military Medicine Section, Dongli District, Logistics University of People's Armed Police Force, 1 Huizhihuan Road, Tianjin, 300309, China
| | - Ning Liu
- State Key Laboratory of Component‑Based Chinese Medicine, College of Pharmaceutical Engineering of Traditional Chinese Medicine, Haihe Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Yang Yu
- State Key Laboratory of Component‑Based Chinese Medicine, College of Pharmaceutical Engineering of Traditional Chinese Medicine, Haihe Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Rui Liu
- State Key Laboratory of Component‑Based Chinese Medicine, College of Pharmaceutical Engineering of Traditional Chinese Medicine, Haihe Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China.
| | - Zheng Li
- State Key Laboratory of Component‑Based Chinese Medicine, College of Pharmaceutical Engineering of Traditional Chinese Medicine, Haihe Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
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Hoshi K, Kunikata H, Aizawa N, Yasuda M, Okabe T, Takizawa H, Abe T, Nakazawa T. Baseline characteristics associated with the incidence of intraocular inflammation after the intravitreous injection of brolucizumab. Int Ophthalmol 2023; 43:4701-4709. [PMID: 38044420 DOI: 10.1007/s10792-023-02870-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/20/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE To investigate baseline characteristics associated with the incidence of intraocular inflammation (IOI) after the intravitreal injection of brolucizumab (IVBr) for the treatment of neovascular age-related macular degeneration (nAMD). METHODS This retrospective study included 66 eyes of 62 consecutive patients with nAMD who received IVBr (18 eyes were treatment naïve and 48 eyes had switched from other anti-vascular endothelial growth factor [VEGF] therapy). Baseline clinical characteristics were compared in non-IOI and IOI groups. RESULTS Although a dry macula was achieved at a high rate even 6 months after IVBr, IOI occurred in 8 of 66 eyes (12.1%; all had switched therapy) during the study period. Baseline characteristics including age, sex, nAMD type, lens status, visual acuity, central macular thickness, and a history of diabetes did not differ between the groups. The number of previous anti-VEGF injections before IVBr was greater in the IOI group (P = 0.004), and the ratio of patients with a laser flare-cell photometry (LFCP) value over 15 photon count per millisecond (pc/ms) was higher in the IOI group (P = 0.017). Multivariate logistic regression analysis showed that a greater number of previous anti-VEGF injections (odds ratio [OR]: 1.12, P = 0.006; area under the curve: 0.82, cut-off score: 14.0) and an LFCP value over 15 pc/ms (OR: 81.6, P = 0.031) were significantly associated with the incidence of IOI after IVBr. CONCLUSION A number of previous anti-VEGF injections greater than 14 and an LFCP value more than 15 pc/ms might be useful predictors of the incidence of IOI after IVBr in eyes with nAMD.
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Affiliation(s)
- Keisuke Hoshi
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Hiroshi Kunikata
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan.
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Naoko Aizawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Masayuki Yasuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Tatsu Okabe
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Hiroki Takizawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Toshiaki Abe
- Division of Clinical Cell Therapy Center for Advanced Medical Research and Development, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Bodaghi B, Khanani AM, Khoramnia R, Pavesio C, Nguyen QD. Gains in the current understanding of managing neovascular AMD with brolucizumab. J Ophthalmic Inflamm Infect 2023; 13:51. [PMID: 37995057 PMCID: PMC10667168 DOI: 10.1186/s12348-023-00369-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/11/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Unresolved retinal fluid and high injection burden are major challenges for patients with neovascular age-related macular degeneration. Brolucizumab addresses these challenges by providing robust vision gains and superior fluid resolution, with the potential for longer treatment intervals. Brolucizumab has been associated with adverse events of retinal vasculitis and retinal vascular occlusion typically in the presence of intraocular inflammation (IOI). To define the incidence of the adverse events, Novartis convened an external safety review committee, which found a rate of 4.6% for definite or probable IOI, 3.3% for retinal vasculitis, and 2.1% for retinal vascular occlusion in the HAWK and HARRIER trials. Novartis also established a coalition to explore 4 areas regarding the adverse events: root cause, patient characterization, event mitigation and vigilance, and treatment protocols for the adverse events. Based on the coalition findings, a risk mitigation framework was developed. Prior to initiating treatment with brolucizumab, it is important to weigh the potential benefit against risk of adverse events and to consider patient risk factors such as prior history of IOI and/or retinal vascular occlusion. To mitigate the potential for IOI-related adverse events, it is important to conduct a thorough dilated eye examination before each injection and closely monitor patients throughout treatment. Patients should be educated on symptoms of IOI to monitor for. Brolucizumab should not be injected in the presence of active IOI. If an adverse event is identified, prompt and intensive treatment should be considered. CONCLUSION Progress has been made in understanding how to mitigate IOI-related adverse events following treatment with brolucizumab.
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Affiliation(s)
- Bahram Bodaghi
- Department of Ophthalmology & Visual Sciences, Sorbonne University, Paris, France
| | - Arshad M Khanani
- Sierra Eye Associates, Reno, NV, USA
- University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Ramin Khoramnia
- Department of Ophthalmology, Heidelberg University, Heidelberg, Germany
| | - Carlos Pavesio
- Department of Uveitis, Moorfields Eye Hospital and University College London, London, UK
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Suite 200, Palo Alto, CA, 94303, USA.
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Coney JM, McCoy JE, Buxy Sinha S, Sonbolian N, Zhou L, Hull TP, Lewis SA, Miller DG, Novak MA, Pendergast SD, Pham H, Platt SM, Rao LJ, Schartman JP, Singerman LJ, Donkor R, Fink M, Zubricky R, Karcher H. One-Year and 18-Month Outcomes in nAMD Patient Eyes Switched to Brolucizumab Alone versus to Brolucizumab Alternating with Other Anti-VEGF Agents. Clin Ophthalmol 2023; 17:3601-3611. [PMID: 38026599 PMCID: PMC10680460 DOI: 10.2147/opth.s432957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023] Open
Abstract
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 ≥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 ≥3 brolucizumab injections over ≥12 or ≥18 months; the alternating brolucizumab (ALT) cohort comprised prior anti-VEGF-treated eyes treated with ≥2 brolucizumab injections and ≥1 other anti-VEGF over ≥12 or ≥18 months. Results A total of 482 eyes received ≥1 brolucizumab injection during the study period. Mean VA changes from baseline were -1.1±15.1 letters (BRO cohort; n = 174) and 1.3±13.0 letters (ALT cohort; n = 47) at Month 12, and 0.0±13.5 letters (BRO cohort; n = 95) and -7.3±17.2 letters (ALT cohort; n = 29) at Month 18. Mean changes in injection intervals were +26.9±48.1 days (BRO cohort) and +11.1±17.3 days (ALT cohort) at Month 12 and +36.3±52.3 days (BRO cohort) and +14.0±19.9 days (ALT cohort) at Month 18. Mean changes in CMT were -35.2±108.1 μm (BRO cohort) and -31.5±91.2 μm (ALT cohort) at Month 12 and -38.9±75.0 μm (BRO cohort) and -9.0±59.9 μm (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.
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Affiliation(s)
| | | | | | | | | | - Thomas P Hull
- Retina Associates of Cleveland Inc, Beachwood, OH, USA
| | - Shawn A Lewis
- Retina Associates of Cleveland Inc, Beachwood, OH, USA
| | | | | | | | - Hang Pham
- Retina Associates of Cleveland Inc, Beachwood, OH, USA
| | - Sean M Platt
- Retina Associates of Cleveland Inc, Beachwood, OH, USA
| | | | | | | | | | - Margaret Fink
- Retina Associates of Cleveland Inc, Beachwood, OH, USA
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Martín-Saborido C, Zarranz-Ventura J, Escobar-Barranco JJ, Garay-Aramburu G, García-Layana A, Donate-López J, Blanch C, Abraldes M. Cost-utility model of new intravitreous units vs. current patient journey model in Spain. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:619-626. [PMID: 37722561 DOI: 10.1016/j.oftale.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/06/2023] [Indexed: 09/20/2023]
Abstract
AIM To compare the effectiveness and costs of the implementation of the Intravitreal Therapy Unit Model, endorsed by the SERV, SECA, SEO and SEDISA, compared to the usual procedure. METHOD Analytical decision model that compares an UTI-type healthcare organization with 4 usual practice scenarios in Spain, in terms of quality-of-life results due to loss of visual acuity and the use of resources. The probability, cost, and quality-adjusted life years (QALYs) were estimated for each scenario proposed. A univariate sensitivity analysis was performed for each of the parameters used in the model. RESULT The model showed that from any of the initial scenarios of the usual practice, transitioning to the UTI-type implementation improves the quality of life of patients and requires lower cost. UTI-type is dominant respect usual practice. The sensitivity analysis showed that the results would not change sign with the variation of any starting variable. CONCLUSIONS Shorten suspicion-needle times is key to maintaining functional vision in patients requiring intravitreal treatment. The UTI-type model seeks the efficiency of ophthalmology services and can produce savings that vary between Є175 and Є85 per patient attended per year.
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Affiliation(s)
- C Martín-Saborido
- Escuela Nacional de Sanidad (ENS), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Centro de Educación Superior Hygiea, UDIMA, Madrid, Spain
| | - J Zarranz-Ventura
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain; Institut de Investigacions Biomèdiques, August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - G Garay-Aramburu
- Servicio de Oftalmología OSI Bilbao Basurto, Begiker, Instiuto de Investigaciones Sanitarias Biocruces Bizkaia, UPV-EHU, Bilbao, Spain
| | - A García-Layana
- Departamento de Oftalmología Clínica, Universidad de Navarra, Pamplona, Spain
| | - J Donate-López
- Hospital Universitario La Luz, Madrid, Spain; Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - C Blanch
- Health Economics and Evidence Strategy, Novartis Farmacéutica, Barcelona, Spain.
| | - M Abraldes
- Servicio de Oftalmología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Instituto Oftalmológico Gómez Ulla, Santiago de Compostela, Spain
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Saitta A, D'Eliseo LA, D'Eliseo D. Efficacy and safety of brolucizumab for serous drusenoid pigment epithelium detachment non-responder to bevacizumab and aflibercept. Eur J Ophthalmol 2023; 33:NP109-NP112. [PMID: 36448189 DOI: 10.1177/11206721221143154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
INTRODUCTION We report the case of a woman with drusenoid pigment epithelial detachment (DPED) in age-related macular degeneration who was successfully treated with two monthly intravitreal injections of brolucizumab after failing to respond to previous intravitreal injections of bevacizumab and aflibercept. CASE DESCRIPTION A 56-year-old woman with mixed DPED and overlying subretinal fluid in her right eye was initially treated with three intravitreal injections of bevacizumab and three intravitreal injections of aflibercept with no visual and anatomical improvement. Switching to intravitreal injection of brolucizumab was performed. After two consecutive monthly intravitreal injections of brolucizumab, optical coherence tomography (OCT) showed first subretinal fluid resolution and then DPED collapse in the following months. After nine months, the best corrected visual acuity had improved from 20/40 to 20/20. There were no signs of retinal atrophy and exudative activity on OCT examination. No serious or minor adverse events were reported during the follow-up period. CONCLUSIONS Switching to intravitreal brolucizumab injection might be an effective therapeutic option for treatment of mixed DPED with subretinal fluid refractory to other anti-VEGF drugs.
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Affiliation(s)
- Andrea Saitta
- Eye Clinic, Santa Maria delle Croci Hospital, Ravenna, Italy
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Cho HJ, Kang KH, Yoon W, Lee J, Kim CG, Kim JW. Intravitreal Brolucizumab and Aflibercept for Polypoidal Choroidal Vasculopathy. J Ocul Pharmacol Ther 2023; 39:653-660. [PMID: 37504966 DOI: 10.1089/jop.2023.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Purpose: To compare the effectiveness of intravitreal injections of brolucizumab and aflibercept in patients with polypoidal choroidal vasculopathy (PCV). Methods: In total, 62 treatment-naive PCV eyes (62 patients) treated with intravitreal brolucizumab or aflibercept were analyzed retrospectively. All patients received a monthly loading injection of antivascular endothelial growth factor for 3 months, followed by further injections as required. Visual and anatomical outcomes were compared between drugs after 12 months of treatment. Results: The improvement in best-corrected visual acuity after 12 months of treatment was not significantly different between the brolucizumab-treated (22 eyes) and aflibercept-treated groups (40 eyes). However, in the brolucizumab-treated group, there was a significantly greater decrease in central retinal thickness (172 vs. 147 μm; P = 0.031) and subfoveal choroidal thickness after treatment (51 vs. 29 μm; P = 0.025). In addition, the regression rate of polypoidal lesions was significantly higher in the brolucizumab-treated group (77.3%, 17/22 eyes) than that in the aflibercept-treated group (45.0%, 18/40 eyes; P = 0.014). Sterile intraocular inflammation showing mild vitritis was observed in 1 of the 22 eyes (4.5%) of brolucizumab-treated patients. Conclusion: Intravitreal brolucizumab injections for PCV showed visual improvement comparable to that of aflibercept during the 12-month treatment period. However, brolucizumab was more effective than aflibercept for the regression of polypoidal lesions and caused a greater decrease in central retinal thickness and subfoveal choroidal thickness.
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Affiliation(s)
- Han Joo Cho
- Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Kyoung Hae Kang
- Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Wontae Yoon
- Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Jihyun Lee
- Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Chul Gu Kim
- Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Jong Woo Kim
- Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
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Holzhauer B, Adewuyi ET. "Super-covariates": Using predicted control group outcome as a covariate in randomized clinical trials. Pharm Stat 2023; 22:1062-1075. [PMID: 37553959 DOI: 10.1002/pst.2329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/01/2023] [Accepted: 07/14/2023] [Indexed: 08/10/2023]
Abstract
The power of randomized controlled clinical trials to demonstrate the efficacy of a drug compared with a control group depends not just on how efficacious the drug is, but also on the variation in patients' outcomes. Adjusting for prognostic covariates during trial analysis can reduce this variation. For this reason, the primary statistical analysis of a clinical trial is often based on regression models that besides terms for treatment and some further terms (e.g., stratification factors used in the randomization scheme of the trial) also includes a baseline (pre-treatment) assessment of the primary outcome. We suggest to include a "super-covariate"-that is, a patient-specific prediction of the control group outcome-as a further covariate (but not as an offset). We train a prognostic model or ensembles of such models on the individual patient (or aggregate) data of other studies in similar patients, but not the new trial under analysis. This has the potential to use historical data to increase the power of clinical trials and avoids the concern of type I error inflation with Bayesian approaches, but in contrast to them has a greater benefit for larger sample sizes. It is important for prognostic models behind "super-covariates" to generalize well across different patient populations in order to similarly reduce unexplained variability whether the trial(s) to develop the model are identical to the new trial or not. In an example in neovascular age-related macular degeneration we saw efficiency gains from the use of a "super-covariate".
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Gabrielle PH, Mehta H, Barthelmes D, Daien V, Nguyen V, Gillies MC, Creuzot-Garcher CP. From randomised controlled trials to real-world data: Clinical evidence to guide management of diabetic macular oedema. Prog Retin Eye Res 2023; 97:101219. [PMID: 37898362 DOI: 10.1016/j.preteyeres.2023.101219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/30/2023]
Abstract
Randomised clinical trials (RCTs) are generally considered the gold-standard for providing scientific evidence for treatments' effectiveness and safety but their findings may not always be generalisable to the broader population treated in routine clinical practice. RCTs include highly selected patient populations that fit specific inclusion and exclusion criteria. Although they may have a lower level of certainty than RCTs on the evidence hierarchy, real-world data (RWD), such as observational studies, registries and databases, provide real-world evidence (RWE) that can complement RCTs. For example, RWE may help satisfy requirements for a new indication of an already approved drug and help us better understand long-term treatment effectiveness, safety and patterns of use in clinical practice. Many countries have set up registries, observational studies and databases containing information on patients with retinal diseases, such as diabetic macular oedema (DMO). These DMO RWD have produced significant clinical evidence in the past decade that has changed the management of DMO. RWD and medico-administrative databases are a useful resource to identify low frequency safety signals. They often have long-term follow-up with a large number of patients and minimal exclusion criteria. We will discuss improvements in healthcare information exchange technologies, such as blockchain technology and FHIR (Fast Healthcare Interoperability Resources), which will connect and extend databases already available. These registries can be linked with existing or emerging retinal imaging modalities using artificial intelligence to aid diagnosis, treatment decisions and provide prognostic information. The results of RCTs and RWE are combined to provide evidence-based guidelines.
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Affiliation(s)
- Pierre-Henry Gabrielle
- Department of Ophthalmology, Dijon University Hospital, Dijon, Burgundy, France; The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Hemal Mehta
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Ophthalmology Department, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Daniel Barthelmes
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Vincent Daien
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, Montpellier University Hospital, Montpellier, France; Institute for Neurosciences of Montpellier, Univ Montpellier, INSERM, Montpellier, France
| | - Vuong Nguyen
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark C Gillies
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Hanhart J, Jeon S, Tuuminen R. Should patient enrollment criteria for anti-VEGF phase III trials be reconsidered. J Diabetes 2023; 15:911-912. [PMID: 37731062 PMCID: PMC10590675 DOI: 10.1111/1753-0407.13468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/07/2023] [Accepted: 08/15/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- Joel Hanhart
- Department of Ophthalmology, Shaare Zedek Medical CenterJerusalemIsrael
- Hebrew University of JerusalemJerusalemIsrael
| | - Sohee Jeon
- Vitreoretinal ServiceKeye Eye CenterSeoulSouth Korea
| | - Raimo Tuuminen
- Department of OphthalmologyKymenlaakso Central HospitalKotkaFinland
- Faculty of Health SciencesBen‐Gurion University of the NegevBeer‐ShevaIsrael
- Helsinki Retina Research Group, Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
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Bodaghi B, Souied EH, Tadayoni R, Weber M, Ponthieux A, Kodjikian L. Detection and Management of Intraocular Inflammation after Brolucizumab Treatment for Neovascular Age-Related Macular Degeneration. Ophthalmol Retina 2023; 7:879-891. [PMID: 37343623 DOI: 10.1016/j.oret.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE To present interim descriptive insights from the OCTOPUS and SWIFT studies on incidence, clinical features, management, and outcomes of intraocular inflammation (IOI), vasculitis, and occlusive vasculitis with brolucizumab treatment (Beovu, Novartis) in patients with neovascular age-related macular degeneration (nAMD) who were anti-VEGF naive or pretreated with anti-VEGFs (ranibizumab or aflibercept). DESIGN OCTOPUS (NCT04239027) and SWIFT (NCT04264819) studies are prospective phase IIIb single-arm, open-label, multicenter studies assessing brolucizumab. SUBJECTS Anti-VEGF naive (OCTOPUS) and pretreated (SWIFT) patients with nAMD. METHODS Interim prespecified analysis on the efficacy end point provided an opportunity to analyze IOI-related safety. Reports of IOI-related adverse events (AEs) were reviewed, and AE images and clinical features and outcomes of each case were analyzed by a review committee. RESULTS Of 505 brolucizumab-treated eyes/patients with median brolucizumab treatment of 8.8 months, 53 eyes demonstrated at least 1 IOI-related AE. The incidence of overall IOI-related AEs was 10.5%; among these events, the incidence was 7.1% for IOI only without retinal involvement and 3.4% for IOI with retinal involvement (2.0% with vasculitis, 1.4% with vascular occlusion with or without vasculitis). Incidence was similar in naive and pretreated patients. Before the onset of the first IOI-related AE, eyes received a median of 2 brolucizumab injections; 81.1% of IOI-related AEs occurred during the loading phase (median, 25.0 days from the last brolucizumab injection). At AE onset, most frequently reported symptoms were floaters (52.8%) and blurred or decreased vision (37.8%). Of the 86.8% of AEs that were treated, most were treated with topical corticosteroids (75.5%), 28.3% by systemic corticosteroids, and 26.8% by intraocular corticosteroids. No severe vision loss was reported for the 7 nontreated AEs. Overall, the median best-corrected visual acuity (BCVA) change at IOI-related AEs resolution from baseline was 1 letter (range, -74 to +32 letters), and 2 patients with occlusive vasculitis had BCVA loss ≥ 15 letters due to IOI-related AEs. All eyes permanently discontinued brolucizumab after the first IOI-related AE. CONCLUSIONS This analysis highlights the need for monitoring and education of patients to report any signs of IOI-related events immediately when being treated with brolucizumab. IOI should be treated promptly and intensely with corticosteroids. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Bahram Bodaghi
- Department of Ophthalmology, IHU FOReSIGHT, Sorbonne University, APHP, Paris, France
| | - Eric H Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université de Paris Est Créteil, Créteil, France
| | - Ramin Tadayoni
- Université Paris Cité, AP-HP, Lariboisière, St Louis and Fondation Adolphe de Rothschild hospitals, Paris, France
| | - Michel Weber
- Clinique Ophtalmologique, CHU de Nantes, 1, place Alexis Ricordeau, 44093 Nantes
| | - Anne Ponthieux
- Novartis Pharma SAS, Rueil-Malmaison, Malmaison, France.
| | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse teaching Hospital, Hospices Civils de Lyon, 69004 Lyon, France; UMR5510 MATEIS, CNRS, INSA Lyon, Université Lyon 1, 69100 Villeurbanne, France
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Booler H, DeLise AM, Nimz E, Shefchek D, Luetjens CM. Intravitreal RTH258 (brolucizumab) demonstrates no effect on pregnancy, parturition, embryofetal or postnatal development in cynomolgus monkeys. Reprod Toxicol 2023; 121:108468. [PMID: 37666285 DOI: 10.1016/j.reprotox.2023.108468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 09/06/2023]
Abstract
RTH258 (brolucizumab) is a humanized single chain antibody fragment, the smallest functional unit of an antibody designed to target vascular endothelial growth factor in angiogenic retinal disease. To further understand the safe use of RTH258, this study assessed the potential impact of intravitreal RTH258 on pre- and postnatal development in the offspring of cynomolgus monkeys following administration to the mother. Three groups of 16 pregnant females were included: a low dose group (RTH258 3 mg/50 µl [60 mg/ml]), a high dose group (RTH258 6 mg/50 µl [120 mg/ml]), and a control group. Maternal animals were administered a single injection of 50 µl in the right eye once every four weeks. Animals were observed daily and detailed observations were collected before and after the first dose, and then weekly thereafter. Following parturition, observations of infants included external, morphological, and ophthalmic examinations; neurobehavioral test battery; grip strength; and skeletal development. Blood samples for hematology, coagulation, and clinical chemistry were collected from non-fasted maternal and infant animals. No RTH258-related deaths occurred in maternal dams or infants. No RTH258-related clinical observations were noted in maternal animals or in surviving infants - there were no changes in gestation length; pregnancy loss; deaths; body weight/weight change; infant grip strength; infant external, morphological, or skeletal evaluations; ophthalmoscopy or neurobehavioral observations; or clinical pathology parameters. RTH258 had no impact on pregnancy or parturition; embryo-fetal development; or survival, growth, or postnatal development of offspring when administered via repeated intravitreal administration.
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Affiliation(s)
| | | | - Erik Nimz
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Matsumoto H, Hoshino J, Nakamura K, Nagashima T, Akiyama H. Short-term outcomes of intravitreal faricimab for treatment-naïve neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2023; 261:2945-2952. [PMID: 37195339 DOI: 10.1007/s00417-023-06116-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/23/2023] [Accepted: 05/10/2023] [Indexed: 05/18/2023] Open
Abstract
PURPOSE To investigate the efficacy and safety of loading phase treatment with 3 monthly intravitreal injections of faricimab for neovascular age-related macular degeneration (nAMD). METHODS We retrospectively analyzed 16-week outcomes of 40 consecutive eyes of 38 patients with treatment-naïve nAMD. Three monthly injections of faricimab were administered to all eyes as a loading phase treatment. Best-corrected visual acuity (BCVA), foveal thickness, central choroidal thickness (CCT), and dry macula achievement were all assessed every 4 weeks. Moreover, the regression of polypoidal lesions was evaluated after the loading phase. RESULTS BCVA was 0.33 ± 0.41 at baseline and showed significant improvement to 0.22 ± 0.36 at week 16 (P < 0.01). Foveal thickness was 278 ± 116 µm at baseline, decreasing significantly to 173 ± 48 µm at week 16 (P < 0.01). CCT was 214 ± 98 µm at baseline, decreasing significantly to 192 ± 89 µm at week 16 (P < 0.01). Dry macula was achieved in 31 eyes (79.5%) at week 16. Indocyanine green angiography after the loading phase revealed complete regression of polypoidal lesions in 11 of 18 eyes (61.1%) with polypoidal lesions. One eye (2.5%) developed vitritis without visual loss at week 16. CONCLUSION Loading phase treatment with intravitreal faricimab appears to generally be safe and effective for improving visual acuity and reducing exudative changes in eyes with nAMD.
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Affiliation(s)
- Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma, 371-8511, Japan.
| | - Junki Hoshino
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Kosuke Nakamura
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Tetsuhiro Nagashima
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Hideo Akiyama
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
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Pakravan P, Patel V, Lai J, Shaheen A, Kalahasty K, Reyes-Capo DP, Chau V, Rosenfeld PJ, Haddock LJ, Schwartz SG, Smiddy WE, Kovach JL, Sridhar J, Flynn HW, Albini TA, Yannuzzi NA. INTRAOCULAR INFLAMMATION INCIDENCE AFTER INTRAVITREAL BROLUCIZUMAB INJECTION FOR EXUDATIVE AGE-RELATED MACULAR DEGENERATION. Retina 2023; 43:1717-1722. [PMID: 37320859 DOI: 10.1097/iae.0000000000003862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE We evaluated the clinical outcomes of intraocular inflammation (IOI) of eyes with neovascular age-related macular degeneration (AMD) injected with brolucizumab in our tertiary referral center. METHODS A retrospective case series for which clinical records of all eyes that received intravitreal brolucizumab at Bascom Palmer Eye Institute between December 1, 2019, and April 1, 2021, were reviewed. RESULTS There were 345 eyes of 278 patients who received 801 brolucizumab injections. IOI was detected in 16 eyes of 13 patients (4.6%). In those patients, baseline Logarithm of Minimu Angle of Resolution (logMAR) best-corrected visual acuity was 0.32 0.2 (20/42), while it was 0.58 0.3 (20/76) at IOI presentation. The mean number of injections among eyes experiencing IOI was 2.4, and the interval between the last brolucizumab injection and IOI presentation was 20 days. There was no known case of retinal vasculitis. Management of IOI included topical steroids in seven eyes (54%), topical and systemic steroids in five eyes (38%), and observation in one eye (8%). Best-corrected visual acuity returned to baseline and inflammation resolved in all eyes by the last follow-up examination. CONCLUSION Intraocular inflammation after brolucizumab injection for neovascular AMD was not uncommon. Inflammation resolved in all eyes by the last follow-up visit.
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Affiliation(s)
- Parastou Pakravan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Zubricky R, McCoy J, Donkor R, Miller DG, Sonbolian N, Heaney A, Bilano V, Karcher H, Coney JM. Real-World Frequency and Management of Ocular Adverse Events in Eyes with Neovascular Age-Related Macular Degeneration Treated with Brolucizumab. Ophthalmol Ther 2023; 12:2397-2408. [PMID: 37310683 PMCID: PMC10442012 DOI: 10.1007/s40123-023-00741-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/17/2023] [Indexed: 06/14/2023] Open
Abstract
INTRODUCTION Intraocular inflammation (IOI)-related adverse events (AEs) that may result in severe vision loss have been associated with the anti-vascular endothelial growth factor brolucizumab. In this study, we investigate the timing, management and resolution of IOI-related AEs in a large cohort of patients treated with at least one injection of brolucizumab in routine clinical practice. METHODS Retrospective review of medical records from patients with neovascular age-related macular degeneration treated with ≥ 1 brolucizumab injection between October 2019 and November 2021 at the Retina Associates of Cleveland, Inc. clinics. RESULTS Of the 482 eyes included in the study, IOI-related AEs occurred in 22 (4.6%) eyes. Four (0.8%) eyes developed retinal vasculitis (RV) and of these, 2 (0.4%) had concomitant retinal vascular occlusion (RO). Most eyes [14/22 (64%)] developed the AE within 3 months and 4/22 (18%) within 3-6 months of the first brolucizumab injection. The median [interquartile range (IQR)] time from the last brolucizumab injection to development of the IOI-related AE was 13 (4-34) days. At the time of event, 3 (0.6%) eyes with IOI (no RV/RO) developed severe vision loss of ≥ 30 ETDRS letters, and a further 5 (1.0%) eyes (1 with IOI + RV, 1 with IOI + RV + RO) developed moderate vision loss of ≥ 15 letters compared with their last visual acuity (VA) prior to the AE. The median (IQR) vision loss was -6.8 (-19.9, -0.0) letters. Taking the best VA at either 3 or 6 months after AE resolution (or stability for occlusive events), VA decreased by ≥ 5 letters compared with prior to the AE in 3 (14%) of the 22 affected eyes, and was preserved (< 5-letter loss) in 18 (82%) eyes. CONCLUSIONS In this real-world study, most IOI-related AEs occurred early after brolucizumab treatment initiation. With appropriate monitoring and management of IOI-related AEs, vision loss associated with brolucizumab may be limited.
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Affiliation(s)
| | - Jasmyne McCoy
- Retina Associates of Cleveland Inc, 24075 Commerce Park, Beachwood, OH, 44122, USA
| | - Richard Donkor
- Retina Associates of Cleveland Inc, 24075 Commerce Park, Beachwood, OH, 44122, USA
| | - David G Miller
- Retina Associates of Cleveland Inc, 24075 Commerce Park, Beachwood, OH, 44122, USA
| | | | | | | | | | - Joseph M Coney
- Retina Associates of Cleveland Inc, 24075 Commerce Park, Beachwood, OH, 44122, USA.
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Iqball S, Beck DK, Devarajan G, Khoo CP, O’Connor DM, Ellis S, Guzman E, Mitrophanous KA, Lad Y. Lentiviral delivered aflibercept OXB-203 for treatment of neovascular AMD. Mol Ther Methods Clin Dev 2023; 30:350-366. [PMID: 37637380 PMCID: PMC10448334 DOI: 10.1016/j.omtm.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 07/12/2023] [Indexed: 08/29/2023]
Abstract
Neovascular age-related macular degeneration (nAMD) is a leading cause of blindness in the aging population, with vascular endothelial growth factor (VEGF) playing a key role. Treatment with recombinant anti-VEGFs is the current standard of care; however, it is only effective for 1-2 months at a time and requires re-administration. Gene therapy could pave the way for stable, long-term expression of therapeutic anti-VEGF with a single dose, reducing the frequency of treatment and potentially improving clinical outcomes. As such, we have developed OXB-203, a lentiviral-based gene therapy encoding the anti-VEGF protein aflibercept. Aflibercept derived from OXB-203 exhibited comparable in vitro binding characteristics to VEGF as recombinant aflibercept. Furthermore, its biological potency was demonstrated by the equivalent inhibition of VEGF-induced human umbilical vein endothelial cell (HUVEC) proliferation and tubule formation as recombinant aflibercept. In a rat choroidal neovascularization (CNV) model of nAMD, a single subretinal administration of OXB-203 reduced laser-induced CNV lesion areas analogous to an intravitreal bolus of recombinant aflibercept. Finally, in a head-to-head comparative study, aflibercept derived from OXB-203 was shown to be expressed at significantly higher levels in ocular tissues than from an AAV8-aflibercept vector following a single subretinal delivery to rats. These findings support the therapeutic potential of OXB-203 for the management of nAMD.
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Affiliation(s)
- Sharifah Iqball
- Oxford Biomedica (UK) Ltd., Windrush Court, Transport Way, OX4 6LT Oxford, UK
| | - Daniel K. Beck
- Oxford Biomedica (UK) Ltd., Windrush Court, Transport Way, OX4 6LT Oxford, UK
| | - Gayathri Devarajan
- Oxford Biomedica (UK) Ltd., Windrush Court, Transport Way, OX4 6LT Oxford, UK
| | - Cheen P. Khoo
- Oxford Biomedica (UK) Ltd., Windrush Court, Transport Way, OX4 6LT Oxford, UK
| | - Deirdre M. O’Connor
- Oxford Biomedica (UK) Ltd., Windrush Court, Transport Way, OX4 6LT Oxford, UK
| | - Scott Ellis
- Oxford Biomedica (UK) Ltd., Windrush Court, Transport Way, OX4 6LT Oxford, UK
| | - Efrain Guzman
- Oxford Biomedica (UK) Ltd., Windrush Court, Transport Way, OX4 6LT Oxford, UK
| | | | - Yatish Lad
- Oxford Biomedica (UK) Ltd., Windrush Court, Transport Way, OX4 6LT Oxford, UK
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MacCumber MW, Wykoff CC, Karcher H, Adiguzel E, Sinha SB, Vishwakarma S, LaPrise A, Igwe F, Freitas R, Ip MS, Zarbin MA. One-Year Brolucizumab Outcomes in Neovascular Age-Related Macular Degeneration from a Large United States Cohort in the IRIS® Registry. Ophthalmology 2023; 130:937-946. [PMID: 37086857 DOI: 10.1016/j.ophtha.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 04/24/2023] Open
Abstract
PURPOSE To evaluate visual acuity (VA) and injection intervals in patients with neovascular age-related macular degeneration (nAMD) after 12 months of brolucizumab therapy in clinical practice. DESIGN Retrospective cohort study. PARTICIPANTS Adults in the United States-based IRIS® Registry (Intelligent Research in Sight) with nAMD who received brolucizumab exclusively for 12 months (2308 eyes of 2079 patients). METHODS Observational study of eyes with a first injection of brolucizumab (index), followed by 2 or more brolucizumab injections over the following 12 months without switching to another anti-vascular endothelial growth factor (VEGF) agent. MAIN OUTCOME MEASURES Primary outcomes were change in best recorded VA and, for eyes receiving prior anti-VEGF therapy (treatment-experienced eyes), the difference between the brolucizumab injection interval at 12 months and the anti-VEGF injection interval before switching. The interval before switching was defined as the time between the prior anti-VEGF and index brolucizumab injections; brolucizumab interval was the time between the closest injection to day 365 and the preceding injection. Secondary outcomes included incident adverse events. RESULTS Overall VA at index was 61.6 ± 18.4 Early Treatment Diabetic Retinopathy Study letters; 83.7% of treatment-naive eyes (184/220) and 86.1% of treatment-experienced eyes (1797/2088) showed stable (< 10 letters gained or lost) or improved (≥ 10 letters gained) VA at 12 months. Among treatment-experienced eyes receiving a prior anti-VEGF injection within 365 days before index, 29.5% (594/2015) showed an interval before switching of 8 weeks or more (mean, 7.6 ± 5.5 weeks), whereas 83.1% (1734/2015) showed a brolucizumab injection interval at 12 months of 8 weeks or more (mean, 10.3 ± 4.0 weeks). In all, 77.1% of treatment-experienced eyes (1554/2015) showed an interval extension of 1 week or more; of these, 55.4% (861/1554) showed an extension of 4 weeks or more. CONCLUSIONS In this community-based study, at 12 months, brolucizumab treatment prolonged the interval between anti-VEGF injections for most treatment-experienced eyes, particularly those with shorter intervals before switching, while maintaining or improving VA. With careful balancing of the benefits and risks, switching to brolucizumab treatment may offer the advantage of extending the treatment interval for patients with a high anti-VEGF therapy burden. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Mathew W MacCumber
- Department of Ophthalmology, Rush University Medical Center, Chicago, and Illinois Retina Associates SC, Harvey, Illinois.
| | | | | | - Eser Adiguzel
- Novartis Pharmaceuticals Corp., East Hanover, New Jersey
| | | | | | | | | | - Rita Freitas
- Novartis Farma-Produtos Farmacêuticos S.A., Porto Salvo, Portugal
| | - Michael S Ip
- Doheny Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - Marco A Zarbin
- Department of Ophthalmology and Visual Science, Rutgers-New Jersey Medical School, Newark, New Jersey
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50
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Timtim E, Weng CY, Finn AP. Safety of recent ophthalmic drugs and devices for wet macular degeneration. Curr Opin Ophthalmol 2023; 34:363-368. [PMID: 37326230 DOI: 10.1097/icu.0000000000000974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE OF REVIEW With frequent antivascular endothelial growth factors (VEGF) injections well established as the standard of care in neovascular age-related macular degeneration (nAMD), focus has now shifted towards decreasing treatment burden without compromising safety and efficacy. This review summarizes clinical stage and recently approved drugs and devices for nAMD, with an emphasis paid to safety concerns and their implications for product adoption. RECENT FINDINGS Three strategies have emerged to decrease the treatment burden associated with the current standard of care: more durable intravitreal agents, sustained-release modalities and gene therapy. The appearance of biosimilars will further impact drug availability and cost. As patterns of adverse events emerge from clinical trial or postmarketing surveillance data, manufacturers have proactively responded by appointing independent review committees or issuing voluntary recalls. However, the example of one biosimilar approved outside of the USA and European Union demonstrates how early safety concerns, even when addressed by substantive data, can generate lingering uncertainty. SUMMARY As the number of promising new treatments in nAMD continues to grow, so too does the amount of data that providers must sift through. The perception of safety surrounding first movers in each new therapeutic area is sure to affect adoption of that modality more broadly.
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Affiliation(s)
- Elise Timtim
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christina Y Weng
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Avni P Finn
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
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