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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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Vogt D, Deiters V, Herold TR, Guenther SR, Kortuem KU, Priglinger SG, Wolf A, Schumann RG. Optimal patient adherence and long-term treatment outcomes of neovascular age-related macular degeneration in real-life. Curr Eye Res 2022; 47:889-896. [PMID: 35179427 DOI: 10.1080/02713683.2022.2044056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To report on long-term real-life outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy in neovascular age-related macular degeneration (nAMD) with optimal patient adherence. METHODS For this retrospective monocenter study, we identified 3217 eyes of 2793 patients that received a minimum of three intravitreal anti-VEGF injections for nAMD therapy between 2006 and 2014 at the University Eye Hospital Munich. From those, we included eyes with treatment-naïve nAMD, follow-up (FU) of ≥60 months and continuous adherence during FU. Primary measures were corrected visual acuity (VA), number of injections and visits as well as treatment regimen. RESULTS We included 161 eyes of 125 patients with a mean FU of 8.0 ± 2.3 years. Mean VA at baseline was 60.1 letters (Snellen equivalent, 20/63). After the third year, mean VA declined constantly by 2-3 letters per year. After 5 and 8 years, 26.1% and 42.1% had lost at least 3 lines from baseline. Mean cumulative number of injections was 5.3 after the first year, and 23.9, 38.1, 48.5 after 5, 8, and 10 years. 'Treat and extent' regimen with higher injection frequency correlated with better function. At time of last FU, 69.8% of eyes were under active treatment. Eyes with ≥70 letters at baseline correlated with better VA at the end of FU. CONCLUSIONS Despite optimal patient adherence, visual function declined progressively in real-life nAMD therapy over long-term. The highest impact on treatment success is given by an early treatment start with individual but intensive anti-VEGF therapy.
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Affiliation(s)
- Denise Vogt
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany
| | - Viktoria Deiters
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany
| | - Tina R Herold
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany
| | - Stefanie R Guenther
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany
| | - Karsten U Kortuem
- Department of Ophthalmology, University Hospital Ulm, Priettwitzstr. 43, 89075 Ulm, Germany
| | - Siegfried G Priglinger
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany
| | - Armin Wolf
- Department of Ophthalmology, University Hospital Ulm, Priettwitzstr. 43, 89075 Ulm, Germany
| | - Ricarda G Schumann
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany.,Munich Eye Center Brienner Hof, Brienner Str. 12, 80333 Munich, Germany
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Initial Pro Re Nata Brolucizumab for Exudative AMD: The PROBE Study. J Clin Med 2021; 10:jcm10184153. [PMID: 34575264 PMCID: PMC8465009 DOI: 10.3390/jcm10184153] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 01/02/2023] Open
Abstract
The present study aimed to determine the efficacy and safety of pro re nata (PRN) intravitreal brolucizumab therapy for neovascular age-related macular degeneration (AMD) without a loading dose in the real-world setting. The PROBE study (Pro Re Nata Brolucizumab for Exudative AMD) is a retrospective, observational, multicentric study that included 27 treatment-naïve patients (27 eyes) with neovascular AMD who received PRN brolucizumab therapy with the treatment interval being at least 8 weeks, should the need for a second consecutive injection arise. The primary outcome measure was changed to best-corrected visual acuity (BCVA) over time. Secondary outcome measures included the determination of change in central subfield thickness (CST) and complications. The mean follow-up was 11.2 ± 1.2 months. The mean baseline and final BCVA were 57.4 ± 4.5 letters and 65.3 ± 3.12 letters, respectively (p = 0.014). The mean gain in letters at the end of follow-up was 7.8 ± 3.5 letters. There was a significant decrease in CST at the end of the follow-up period (p = 0.013). Patients received a mean of 2.2 ± 0.9 injections (in addition to the first mandatory injection) during the follow-up period. There were no adverse events noted. In conclusion, initial PRN brolucizumab for exudative AMD without a loading dose demonstrated significant visual improvement and no adverse events.
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Bilgic A, Kodjikian L, March de Ribot F, Vasavada V, Gonzalez-Cortes JH, Abukashabah A, Sudhalkar A, Mathis T. Real-World Experience with Brolucizumab in Wet Age-Related Macular Degeneration: The REBA Study. J Clin Med 2021; 10:jcm10132758. [PMID: 34201729 PMCID: PMC8268719 DOI: 10.3390/jcm10132758] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 11/29/2022] Open
Abstract
The aim of the present study was to determine the efficacy and safety of intravitreal brolucizumab therapy for neovascular age-related macular degeneration (AMD) in the real-world setting. The REBA study (real-world experience with brolucizumab in wet AMD) was a retrospective, observational, multicentric study that included 78 consecutive patients (105 eyes), with neovascular AMD, who received brolucizumab therapy. Both treatment-naive and switch-therapy patients were included. Switch therapy was based either on fluid recurrence, fluid recalcitrance, or inability to extend beyond q4/q6. All relevant data were collected. The primary outcome measure was change in best-corrected visual acuity (BCVA) over time. Secondary outcome measures included determination of change in central subfield thickness (CST) and complications. The mean baseline BCVA was 49.4 ± 5.4 letters and 40 ± 3.2 letters, and corresponding mean BCVA gain was +11.9 ± 3.9 letters (p = 0.011) and +10.4 ± 4.8 letters (p = 0.014) in the treatment-naive and switch-therapy groups, respectively. The change in CST was significantly decreased in the treatment-naive (p = 0.021) and the switch-therapy (p = 0.013) groups. The mean follow-up was 10.4 months in both groups. One patient in the switch-therapy group developed vascular occlusion and another a macular hole after the fifth brolucizumab injection. Both patients recovered uneventfully. In conclusion, patients showed a very good anatomical and functional response to brolucizumab therapy in the real world, regardless of prior treatment status, until the end of the follow-up period. Two significant untoward events were noted.
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Affiliation(s)
- Alper Bilgic
- Alphavision Augenarztpraxis, 27568 Bremerhaven, Germany;
| | - Laurent Kodjikian
- Service d’Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 69004 Lyon, France; (L.K.); (A.A.); (T.M.)
- UMR-CNRS 5510, Matéis, Villeurbane, 69004 Lyon, France
| | | | | | | | - Amro Abukashabah
- Service d’Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 69004 Lyon, France; (L.K.); (A.A.); (T.M.)
- Ophthalmology Department, King Abdulaziz University, Rabigh 25732, Saudi Arabia
| | - Aditya Sudhalkar
- Alphavision Augenarztpraxis, 27568 Bremerhaven, Germany;
- MS Sudhalkar Medical Research Foundation, Baroda 390001, India
- Correspondence: ; Tel.: +91-265-279-3799
| | - Thibaud Mathis
- Service d’Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 69004 Lyon, France; (L.K.); (A.A.); (T.M.)
- UMR-CNRS 5510, Matéis, Villeurbane, 69004 Lyon, France
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