Longitudinal, real-world study of outcomes for brolucizumab in wet age-related macular degeneration in Malaysia

Abstract

This research was conducted to evaluate the real-world evidence of brolucizumab for wet AMD (nAMD) treatment, including refractory nAMD, on visual acuity (VA), central retinal thickness (CRT) and fluid compartments on Optical Coherence Tomography (OCT). Medical records of nAMD patients attending 12 Malaysian centres between 01/10/2020 to 17/10/2023 were retrospectively reviewed. nAMD eyes receiving at least one brolucizumab injection during the study period were included. VA, OCT fluid compartments and CRT, and safety outcomes were evaluated at baseline, months 1, 3, 6, 9 and 12. Changes in VA and CRT across time were explored using mixed effect linear regression, while the change in fluid compartment were explored using mixed effect logistic regression. 155 eyes were analyzed. Mean VA improved significantly at month 3 (LogMAR 0.45, p=0.006). Mean CRT decreased significantly at all time points (all p value <0.001). For intraretinal fluid (IRF), a significant decrease shown at months 3 (p=0.001) and month 6 (p=0.008). For subretinal fluid (SRF) and pigment epithelial detachment (PED), significant decrease occurred at all time points (p<0.05). Treatment burden reported was 5.4 injections and 8.0 visits in one year. For safety outcomes, 12 (7.74%) intraocular inflammation (IOI) and 5 (3.02%) vasculitis cases were reported. For the discontinuation rates, resulting in an 18.06% discontinuation rate from brolucizumab, mainly due to adverse event occurrence. Brolucizumab was associated with significant VA gain in short terms at 3 months but not in long term at months 12. For CRT, significant decrease reported up to 1 year (all p<0.001). Brolucizumab caused significant drying effect on fluid compartments for IRF in the short terms (months 3 and 6), while SRF and PED in longer terms up to 12 months in real-world Malaysian patients with nAMD (all p<0.001). Treatment burden reported was lower than other studies. For the safety issues, IOI is higher while vasculitis cases are the same as reported elsewhere.