Brolucizumab versus aflibercept in treating exudative age-related macular degeneration: a 12-month pro re nata regimen

We compared 12-month treatment outcomes of intravitreal injections of brolucizumab (IVBr) with aflibercept (IVA) for treatment-naïve exudative age-related macular degeneration (AMD). Patients were given three monthly IVBr or IVA injections and were followed up monthly for 12 months. Additional injections were given if exudation or hemorrhage recurred. The study included 339 eyes in 339 patients divided into the IVBr or IVA groups. In both groups, central retinal thickness (CRT) and subfoveal choroidal thickness significantly decreased, and best-corrected visual acuity (BCVA) significantly improved at the 12-month visit. BCVA improvement was similar in both groups (P = 0.27). Age, baseline BCVA, and thickness of the central retina and subfoveal choroid were associated with the 12-month BCVA. The proportion of patients who did not require additional injections was 33% in the IVBr and 30% in the IVA group (P = 0.58). The number of additional injections showed a trend favoring IVBr over IVA but the difference was insignificant (P = 0.055). Age, risk alleles of ARMS2 A69S, and baseline CRT were associated with shorter retreatment-free period. In conclusion, IVBr achieved similar visual and anatomic treatment outcomes to IVA with a trend toward requiring fewer additional injections during 12-month follow-up of as-needed regimen for exudative AMD.