Brolucizumab for Wet Age-related Macular Degeneration in Switch Patients: Long-Term Real-World Experience from a Tertiary Center

Objective: To evaluate the three-year real-world efficacy and safety of intravitreal brolucizumab injections in patients with neovascular age-related macular degeneration (nAMD) who switched from other anti-vascular endothelial growth factor (VEGF) therapies. Design: Retrospective, single-center, observational cohort study. Subjects: The study included 97 eyes of 91 patients with nAMD previously treated with anti-VEGF therapies who completed three years of follow-up. Methods: Patients received intravitreal injections of 6 mg brolucizumab. Data on Best Corrected Visual Acuity (BCVA), Central Subfield Thickness (CST), Intraretinal Fluid (IRF), Subretinal Fluid (SRF), sub-Retinal Pigment Epithelium Fluid (sRPEF), treatment intervals, and adverse events were collected over a three-year follow-up period. Results: The mean age of patients was 78.9±8.2 years, with a mean follow-up of 161.3 weeks. At three-year follow up, mean BCVA significantly improved, from 41.1±6.5 at baseline to 50.7±7.5 ETDRS letters (p<0.001), and mean CST significantly decreased from 371.3±136.7 to 299.1±137.81 (p<0.001). Significant reductions were observed in IRF (p<0.001), SRF (p<0.001), and sRPEF (p=0.004). Mean injections per year were 4.7±1.9, 3.9±1.7, and 3.6±1.9 in the first, second, and third years, respectively. Adverse events were noted in four patients after either the first or second injection, with no further events reported. Conclusion: This study reports that brolucizumab provides favorable anatomical and functional outcomes and can reduce treatment burden in patients with nAMD due to its rapid and sustained efficacy and favorable safety profile.