Efficacy and Safety of Switching from Ranibizumab to Brolucizumab in Age-Related Macular Degeneration: Multicenter Real-World Outcomes

Libor Hejsek,1,2 Michal Hrevuš,3,4 Maria Burova,1,2 David Beran,1,2 Zuzana Cyžová,3,4 Martin Penčák,5,6 Tereza Pařilová,7 Dana Liláková,1,2 Miroslav Veith5,6 1Eye Clinic, University Hospital Hradec Králové, Hradec Králové, Czech Republic; 2Eye Clinic, Charles University Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic; 3Eye Clinic, Olomouc University Hospital, Olomouc, Czech Republic; 4Eye Clinic, Palacký University Faculty of Medicine and Dentistry, Olomouc, Czech Republic; 5Ophthalmology Clinic, University Hospital Královské Vinohrady, Praha, Czech Republic; 6 3rd Faculty of Medicine, Charles University, Praha-Vinohrady, Czech Republic; 7Department of Preventive Medicine, Charles University Faculty of Medicine in Hradec Králové, Hradec Králové, Czech RepublicCorrespondence: Libor Hejsek, Eye Clinic, University Hospital in Hradec Kralove, Sokolska 581, Hradec Kralove, 50006, Czech Republic, Email [email protected] Tereza Pařilová, Department of Preventive Medicine, Charles University Faculty of Medicine in Hradec Králové, Šimkova 870, Hradec Králové, 50003, Czech Republic, Email [email protected]: To assess whether switching from ranibizumab (0.5 mg) to brolucizumab (6 mg) improves injection intervals, disease activity, and anatomical/functional outcomes in wet age-related macular degeneration (wAMD).Methods: This multicenter retrospective study included patients aged ≥ 50 years with active wAMD, baseline visual acuity (VA) 35– 70, lesion size ≤ 8 disc areas, and submacular hemorrhage ≤ 25%. All had prior ranibizumab and were switched to brolucizumab for suboptimal response. VA and central retinal thickness (CRT) were recorded at switch, 6, and 12 months. Injection counts before and after switching were analyzed. Safety was monitored for intraocular inflammation (IOI) and discontinuation.Results: Seventy-nine eyes (75 patients) were enrolled; 66 eyes (60 patients, median age 75.0 years [IQR: 70.0– 80.0]) completed 12 months. Patients received median 12.0 ranibizumab injections [IQR: 8.0– 19.0] pre-switch and 5.0 brolucizumab injections [IQR: 4.0– 6.0] post-switch. Median switch VA was 50.0 letters [IQR: 36.5– 63.0]; CRT was 319.0 μm [IQR: 258.0– 393.0]. At 6 months, VA improved to 51.0 [IQR: 38.0– 66.5] (p = 0.0001) and CRT decreased to 255.0 μm [IQR: 216.0– 298.0] (p < 0.00000001). At 12 months VA was 50.5 [IQR: 38.5– 68.0] (p = 0.0004 vs baseline) and CRT 251.5 μm [IQR: 207.5– 282.5] (p < 0.0001). Adverse events included 6 IOI cases, with discontinuation in 9 eyes overall.Conclusion: Switching to brolucizumab reduced CRT, modestly improved or stabilized VA, and decreased injection frequency with acceptable safety. Limitations include retrospective design, modest sample size, and exclusion of poor visual outcomes, potentially introducing selection bias.Keywords: wet age-related macular degeneration, anti-VEGF therapy, ranibizumab, brolucizumab, switch, real outcomes