4CPS-129 The usefulness of brolucizumab in treating neovascular age-related macular degeneration not responding to ranibizumab or aflibercept. A retrospective chart review

<h3>Background and Importance</h3> The standard of care for neovascular age-related macular degeneration (nAMD) uses anti-vascular endothelial growth factor (anti-VEGF) drugs: ranibizumab and aflibercept. Our P&amp;T committee has approved brolucizumab for patients not responding to ranibizumab or aflibercept. The regimes of injections at fixed intervals represent a considerable care burden for ophthalmology services and a heavy treatment burden for patients. For this reason, the treat and extend regimen (T&amp;E) began to be applied. This proactive approach consists of fixed treatment doses until disease remission occurs. Then, the therapy interval is progressively extended until neovascular activity reappears. <h3>Aim and Objectives</h3> In actual clinical practice, the choice of drugs for nAMD treatment is not solely based on clinical trials or EMA’s product characteristics. It heavily relies on the clinical experience of ophthalmologists, published observational studies, and expert opinions. Data regarding the use of brolucizumab in patients not responding to other anti-VEGF are scarce. This study, therefore, takes a practical and relevant approach by evaluating the response to brolucizumab in these patients. <h3>Material and Methods</h3> This was a retrospective chart review using electronic medical records at an academic health system. The study included adult patients with nAMD not responding to other anti-VEGF and who had initiated brolucizumab before September 2023. The observational period ended on September 2024. The primary outcome was a response to treatment, i.e., the absence of activity (or reduction) detected by the Ocular Computerised Tomography (OCT) after the loading doses. Signs of toxicity were also recorded. <h3>Results</h3> Among the 37 patients in the cohort, 26 (70,2%) were deemed responders to treatment with brolucizumab. All the included except one (36) have failed in previous aflibercept and/or ranibizumab. All were treated using the T&amp;E approach. Only 2/37 patients referred mild signs of ocular toxicity (discomfort). Among responders, the median number of injections in 12 months was 5 (Inter quartile range 4–6) <h3>Conclusion and Relevance</h3> Brolucizumab appears as a helpful option in nAMD patients who do not respond to aflibercept or ranibizumab. No conclusions can be drawn regarding safety. Response was achieved by a T&amp;E approach with Injections every 2–3 months during the first year. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest