Twelve-Month Outcomes of Anti-VEGF Therapy for nAMD with Brolucizumab, Aflibercept, and Ranibizumab in the Polish National Registry: A Multicenter Database Study

<b>Background/Objectives:</b> Real-world registries of neovascular age-related macular degeneration (nAMD) treatments provide critical insights for optimizing patient care and resource allocation. This study evaluates one-year outcomes of anti-VEGF therapy with aflibercept, ranibizumab, and brolucizumab in the Polish Therapeutic Program Monitoring System between 1 January 2016 and 31 October 2023. <b>Methods:</b> We analyzed data from 51,902 treatment-naïve patients with nAMD, comparing baseline characteristics and outcomes across drugs, as well as between those who discontinued therapy early and those treated for at least one year. <b>Results:</b> No significant baseline differences were found between drug groups. One-year follow-up was available for 40,396 eyes; 3184 were lost to follow-up, and 8322 discontinued treatment: 14.4% for those receiving aflibercept, 24.1% for those receiving brolucizumab, and 20.1% for those receiving ranibizumab. Early discontinuers were older and had higher baseline visual acuity (aflibercept, ranibizumab). Twelve-month treatment outcomes, particularly visual acuity gains and injection frequency (~6-7/year), were similar across agents. Only ~22% achieved at least 0.3 logMAR improvement, underscoring real-world treatment challenges. <b>Conclusions:</b> System-level support, appropriate treatment intensification, and strategic use of newer, durable agents like brolucizumab are crucial to narrowing the gap between clinical trial efficacy and real-world effectiveness, ultimately improving long-term outcomes in nAMD care.