Brolucizumab for Neovascular Age-Related Macular Degeneration (BEL Study)

Liesbeth Van Cleemput,1,2 Freya Peeters,1,2 Julie Jacob1,2 1Department of Ophthalmology, University Hospital Leuven, Leuven, Belgium; 2Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, BelgiumCorrespondence: Liesbeth Van Cleemput, Department of Ophthalmology, University Hospital Leuven, Herestraat 49, Leuven, 3000, Belgium, Tel +32 470 86 72 56, Fax +32 16 33 23 67, Email liesbeth.vancleemput@uzleuven.bePurpose: This retrospective observational study reports early results on a cohort of neovascular age-related macular degeneration (nAMD) patients switched to brolucizumab, a recently approved anti-vascular endothelial growth factor (anti-VEGF).Patients and Methods: We evaluated best-corrected visual acuity (BCVA), treatment interval, central subfield retinal thickness (CST) and the presence of intra-retinal (IRF), subretinal (SRF) and/or sub-retinal pigment epithelium (sub-RPE) fluid on optical coherence tomography (OCT). Concurrently, patients were carefully examined for signs of intra-ocular inflammation (IOI) and other adverse events.Results: Seventeen patients (19 eyes) were included. The difference in BCVA at baseline compared to the last examination following brolucizumab injection was not statistically significant (Wilcoxon signed-rank test, p=0.247). Mean CST decrease was − 5.16 ± 48.28 μm (p=0.647). A morphological improvement in IRF was observed in four eyes, with a complete resolution in 50% (n=2) and a decrease in 50% (n=2). Regarding SRF (total n=15), resolution was seen in 46.67% (n=7), decrease in 26.67% (n=4) and stabilization in 13.33% (n=2). Increase in SRF was observed in 13.33% (n=2). Of 14 eyes with sub-RPE fluid, 7.14% (n=1) demonstrated a resolution, 42.86% (n=6) a decrease, 50% (n=7) a stabilization and none an increase in fluid. Mean treatment interval was increased by 4.08 ± 1.40 weeks (p< 0.001). Treatment was discontinued in seven eyes (41.18%), including four cases due to IOI. In all four cases, inflammation was mild and resolved under corticosteroid treatment. No cases of vasculitis were observed.Conclusion: This study provides additional data suggesting that brolucizumab is a beneficial alternative for patients refractory to other anti-VEGF therapies. It can provide a morphological reduction in fluid and prolong the treatment interval, while maintaining a stable BCVA and CST. However, as a higher occurrence of IOI is probable, patients should be informed, selected and monitored carefully. Signs of inflammation should be detected early and treated promptly.Keywords: macular degeneration, vascular endothelial growth factor A, intravitreal injections, treatment outcome, inflammation