Real-World Experience with Brolucizumab Compared to Aflibercept in Treatment-Naïve and Therapy-Refractory Patients with Diabetic Macular Edema

[EyeMatics-Multicenter data evaluation of real-world data with interoperable medical informatics]

The evaluation of real-world data (RWD) enables insights to be gained from a wide range of patient data collected in routine clinical practice. In addition, multicenter analyses represent a broad and representative patient population and have the potential to capture the actual treatment situation. As a basis for this, the definition of datasets and an infrastructure for data exchange is necessary. Data integration centers (DIC) have already been established at (university) hospitals throughout Germany in order to extract RWD for scientific analyses from the various source systems and integrate them into research-compatible data infrastructures. The project described here aims to demonstrate the added value of this data integration using a case of application in ophthalmology, defining a core dataset as an ophthalmology extension module and establishing a cross-site data exchange infrastructure. As a first step, the treatment success of eye diseases treated with intravitreal injection (IVI) should be improved. To achieve this goal a dashboard for clinical data is provided that clearly visualizes the merged data. Furthermore, algorithms will be developed to identify new imaging biomarkers that can be used for treatment monitoring and predict treatment outcomes.

Efficacy & safety of brolucizumab 6.0 mg versus 3.6 mg in diabetic macular edema

BACKGROUND

Management of Diabetic Macular edema (DME) requires repeated injections. Therefore newer Anti-VEGFs like Brolucizumab with longer durability have been introduced. We compared two different dosages of Brolucizumab, 6.0 mg and 3.6 mg, for their safety & efficacy in treatment of DME, in treatment naïve patients over 52 weeks.

METHOD

A prospective, pilot randomised controlled, single centre, double blinded, two arm comparative study was conducted between Dec 2022 to Apr 2024. The study recruited 82 patients of DME who were randomised into two groups of 41 patients each, one group to be treated with Brolucizumab 6.0 mg in 50 μL and the other to receive 3.6 mg in 30 μL. All patients received the first dose of Brolucizumab at 0 week and were then followed up at every 4 weeks for detailed ophthalmic and OCT macula examination. Those who met the pre-defined re-treatment criteria were re-injected with Brolucizumab, the dose being fixed for each group throughout the study. All patient receiving an injection were further followed up on Day 1, Day 7 and Day 28 to look for any adverse reactions. The efficacy parameters included change in best corrected visusal acuity (BCVA), contrast and central macular thickness (CMT) on Optical Coherence Tomography. The average number of injections recd in each group were also calculated.

RESULTS

The change in BCVA from baseline in 6.0 mg group was 0.54 LogMAR units and 3.6 mg group was 0.59 LogMAR units, which was not statistically significant. The reduction in CMT from baseline in 6.0 mg group was 133.2 µm (μ) and 3.6 mg group was 110.6 μ, which was not statistically significant. The improvement in contrast from baseline in 6.0 mg group was 0.74 and 3.6 mg group was 0.95, with p value of 0.0002. The re-injection interval was 14.21 weeks in 6.0 mg group and 15.56 weeks for 3.6 mg subgroup. The total number of adverse events in both groups were similar at 70 in 6.0 mg group and 47 in 3.6 mg group with only one grade 4 adverse event occurring in each group.

CONCLUSION

The results of present study show that the safety and efficacy of both doses of Brolucizumab, i.e. 6.0 mg and 3.6 mg, for treating diabetic macular edema is similar. Trial registration Study was registered with Clinical trials registry of India (CTRI ref no. CTRI/2023/06/054105), registered on 14 Nov 2022.

Intravitreal therapy for the management of diabetic retinopathy: A concise review

Diabetic retinopathy (DR) is a serious microvascular complication of diabetes mellitus and may result in irreversible visual loss. Laser treatment has been the gold standard treatment for diabetic macular edema and proliferative diabetic retinopathy for many years. Of late, intravitreal therapy has emerged as a cornerstone in the management of DR. Among the diverse pharmacotherapeutic options, anti-vascular endothelial growth factor agents have demonstrated remarkable efficacy by attenuating neovascularization and reducing macular edema, thus preserving visual acuity in DR patients.

Brolucizumab versus Aflibercept in Patients with Diabetic Macular Edema: A Meta-Analysis of Randomized Controlled Trials

Purpose

To assess efficacy and safety of brolucizumab versus aflibercept in patients with diabetic macular edema (DME).

Patients and Methods

We performed a systematic review and meta-analysis with trial sequential analysis (TSA). We searched Embase, Cochrane Central Register of Controlled Trials and PubMed databases from inception to February 16, 2024 for randomized controlled trials (RCTs) comparing brolucizumab with aflibercept in patients with DME and reporting any of the visual, anatomical and safety outcomes of interest. We conducted a TSA of safety outcomes to assess the risk of statistical errors.

Results

1253 patients (1253 eyes) from 3 RCTs were included, of whom 57% received brolucizumab and 43% received aflibercept. Mean follow-up ranged from 52 to 100 weeks. Brolucizumab was non-inferior to aflibercept when comparing the mean change of best-corrected visual acuity from baseline (least squares mean difference [LSMD] 0.29; 95% confidence interval [CI] -1.37 to 1.95; p = 0.73). Change in central subfield thickness was significantly greater in the brolucizumab group compared with aflibercept (LSMD -24.5 μm; 95% CI -48.2 to -0.7 μm; p < 0.05). Incidence of adverse events of special interest (AESIs) (risk ratio [RR] 1.7; p = 0.08) and incidence of ≥1 ocular adverse events (AEs) (RR 0.95; p = 0.45) were not significantly different between groups.

Conclusion

Brolucizumab was non-inferior in functional outcomes and was superior to aflibercept in anatomical parameters. Ocular AEs and AESIs were numerically low and not statistically significant. Our findings underscore the importance of new RCTs powered to assess safety outcomes in order to suggest brolucizumab as an alternative to the treatment of DME.

Insights into Cataract Surgery Outcomes in Age-Related Macular Degeneration: Perspectives across Severity Grades Under Clinical Routine Conditions

PURPOSE

Cataract and age-related macular degeneration (AMD) share age as a main risk factor and thus have a high coincidence. Both conditions substantially reduce visual acuity. This study aimed to assess the impact of cataract surgery on visual acuity, retinal morphology, and VEGF inhibitor therapy in patients with AMD.

DESIGN

This study was designed as a retrospective, monocentric, real-world study.

SUBJECTS

Patients diagnosed with either dry AMD or neovascular AMD undergoing cataract surgery at Charité Campus Benjamin Franklin.

METHODS

Treatment data were extracted from the Berlin Macular Registry. Best-corrected visual acuity (BCVA) and macular OCT parameters, including central retinal thickness (CRT), macular volume (MV), presence of macular edema, intraretinal or subretinal fluid, and pigment epithelial detachment were assessed.

MAIN OUTCOME MEASURES

The primary outcome measure was the postoperative BCVA. Secondary outcomes included postoperative CRT, MV, changes in qualitative OCT parameters, alterations in anti-VEGF-therapy interval, and postoperative complications.

RESULTS

A total of 418 eyes of 418 patients were included in the analysis with a mean follow-up time of 18.8 (2-62) months. They were classified into a neovascular AMD (n = 85) and a dry AMD (n = 333) cohort. Mean BCVA improved significantly in the neovascular AMD cohort from 0.69 ± 0.45 logarithm of the minimum angle of resolution (logMAR) to 0.47 ± 0.42 (P < 0.001) and in the dry AMD cohort from 0.53 ± 0.47 logMAR to 0.27 ± 0.32 (P < 0.001) at the 2-month follow-up. Improvements in BCVA were sustained to the final visit (18.8 ± 19.5 months after surgery) with BCVA at 0.46 ± 0.38 logMAR (P < 0.001) and 0.26 ± 0.34 logMAR (P < 0.001), respectively. Temporary postoperative increases in CRT and MV were observed, reverting to preoperative levels by 6 months after surgery. The need for anti-VEGF therapy did not change postoperatively in patients with neovascular AMD.

CONCLUSIONS

Within this retrospective analysis, on average, patients with coincident AMD of all severity grades meeting the inclusion criteria benefited from cataract surgery. Transient increases in retinal thickness and MV returned to baseline within 6 months after surgery. The need for intravitreal injections in neovascular AMD subjects was unchanged after surgery. Overall, the study suggests no adverse long-term macular changes attributable to cataract surgery.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.