| Summary: | Joseph M Coney,1 Jasmyne E McCoy,1 Samriddhi Buxy Sinha,2 Nina Sonbolian,2 Lujia Zhou,3 Thomas P Hull,1 Shawn A Lewis,1 David G Miller,1 Michael A Novak,1 Scott D Pendergast,1 Hang Pham,1 Sean M Platt,1 Llewelyn J Rao,1 Jerome P Schartman,1 Lawrence J Singerman,1 Richard Donkor,1 Margaret Fink,1 Ryan Zubricky,4 Helene Karcher2 1Retina Associates of Cleveland Inc, Beachwood, OH, USA; 2Novartis Pharma AG, Basel, Switzerland; 3KMK Consulting, Morristown, NJ, USA; 4Geisinger Eye Institute, Danville, PA, USACorrespondence: Joseph M Coney, Retina Associates of Cleveland Inc, 24075 Commerce Park, Beachwood, OH, 44122, USA, Tel +1 (216) 831-5700, Email jconey@retina-assoc.comObjective: 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.Keywords: alternating anti-VEGF treatments, brolucizumab, neovascular age-related macular degeneration, wet age-related macular degeneration, 12-month outcomes, 18-month outcomes
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