Intravitreal Brolucizumab in Patients with Aflibercept-Resistant Neovascular Age-Related Macular Degeneration

Purpose: To determine the efficacy of brolucizumab in patients with aflibercept resistant neovascular age-related macular degeneration (AMD). Methods: This case series retrospectively collected data from October 2019 to March 2020 of 13 patients detailing aflibercept-resistant AMD. Patients received at least three doses of 2?mg/0.05?mL aflibercept on a 4-week dosing schedule before switching to three doses of 6?mg/0.05?mL brolucizumab on a 4-week schedule. Central subfield thickness (CST) and visual acuity (VA) were measured before and after each drug?s administration. Results: The mean baseline VA was logMAR 0.85 [0.65], which worsened to logMAR 0.86 [0.53] after aflibercept. The VA improved to a mean of logMAR 0.70 [0.44] with brolucizumab, but this fell short of significance (0.70, 95% CI: 0.40-1.00; P?=?0.16). The mean baseline CST was 354.62 [93.79] ?m, and it worsened to 369.31 [116.61] ?m after aflibercept administration. Following the brolucizumab treatment, the mean CST significantly improved to 290.46 [89.84] ?m (290.46, 95% CI: 228.21-352.72; P?=?0.03). After brolucizumab use, there was no observed occlusive retinal vasculitis in this case series. Conclusion: Brolucizumab significantly improved CST, but the VA improvement fell short of significance. Three individuals experienced inflammation following brolucizumab use, but there were no observed occlusive retinal vasculitis. While brolucizumab may not be the first option to treat AMD, it holds value for patients who have been unresponsive to other anti-vascular endothelial growth factor agents.