MODIFIED PRO RE NATA REGIMEN OF BROLUCIZUMAB IN TREATMENT-NAIVE NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

To study the efficacy and safety of pro re nata regimen of brolucizumab, without loading dose, in treatment-naive patients with neovascular age-related macular degeneration.

Retrospective, observational study. We included all consecutive patients diagnosed with treatment-naive neovascular age-related macular degeneration undergoing brolucizumab treatment in the Humanitas eye clinic, Turin, Italy between April 2022 and May 2023. Treatment was performed following pro re nata regimen without loading phase. Injection intervals (time between two injections), adverse events, changes in best corrected visual acuity, central macular thickness, maximal retinal thickness, and intraretinal and subretinal fluid were evaluated descriptively up to 1 year after the first injection.

Twenty-one eyes of 21 patients were included in the study. The mean number of injections was 2.4 ± 0.7 at 3 months, 3.0 ± 2.0 at 6 months, 3.1 ± 2.4 at 9 months, and 3.8 ± 2.8 at 12 months, respectively. Best corrected visual acuity significantly improved from 20/80 Snellen (0.6 ± 0.3 LogMAR) to 20/50 Snellen (0.4 ± 0.3 LogMAR) at month 12 ( P = 0.044). Central macular thickness and maximal retinal thickness significantly reduced from 426 µm and 606 µm at baseline to 248 µm and 356 µm at 1-year follow-up ( P = 0.00067 and P = 0.02, respectively). Subretinal fluid and intraretinal fluid also progressively resolved. In contrast, intraocular inflammation events occurred in 9.5% of patients during follow-up. Intraocular inflammation resolved in all patients with prompt treatment without visual sequelae.

In our study, pro re nata regimen of brolucizumab without loading phase seems to be an effective treatment option in treatment-naive neovascular age-related macular degeneration patients, with intraocular inflammation rate similar to the one reported in trials and lower number of injections.