Efficacy of Brolucizumab in Polyp Regression of Treatment-Naive Polypoidal Choroidal Vasculopathy and Its Effect on 1-Year Treatment Outcome
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Purpose: To evaluate the efficacy of intravitreal brolucizumab in polyp regression of treatment-naive polypoidal choroidal vasculopathy (PCV) patients and its effect on 1-year treatment outcome. Methods: Medical records of 31 treatment-naive PCV patients, who received three monthly intravitreal brolucizumab injections followed by as-needed injections for at least a year, were retrospectively reviewed. Visual and anatomical outcomes were evaluated at 3, 6, and 12 months. Complete polyp regression rate and percentage change of vascular lesion and polyp area were evaluated after three monthly injections of brolucizumab. The effect of complete polyp regression and the impact of vascular lesion and polyp reduction rate on 1-year treatment outcome were also evaluated. Results: In terms of visual outcome, best-corrected visual acuity significantly improved after 12-month follow-up (p < 0.001). In terms of anatomical outcome, central macular thickness (CMT) and central choroidal thickness significantly decreased after 12-month follow-up (p < 0.001). Complete polyp regression was observed in 23 patients (74.2%) after three monthly injections. Group with complete polyp regression had a higher rate of achieving dry macula at 3 months (p = 0.026) and fewer number of injections (p < 0.001) compared to the group without complete polyp regression. Higher polyp reduction rate was significantly associated with higher CMT change from baseline at 3 months (p = 0.048) while higher vascular lesion reduction rate was significantly associated with higher CMT change from baseline at 12 months (p = 0.031) and fewer number of injections (p = 0.012). Conclusions: Intravitreal brolucizumab injection effectively improved visual and anatomical outcomes and achieved significant polyp regression in treatment-naive PCV patients. Complete polyp regression and the reduction rate of vascular lesion size and polyp size after loading injection significantly influence the treatment outcome of PCV patients. However, careful monitoring and preoperative warning is warranted due to occurrence of brolucizumab-related IOI.
Abstract
Purpose: To evaluate the efficacy of intravitreal brolucizumab in polyp regression of treatment-naive polypoidal choroidal vasculopathy (PCV) patients and its effect on 1-year treatment outcome. Methods: Medical records of 31 treatment-naive PCV patients, who received three monthly intravitreal brolucizumab injections followed by as-needed injections for at least a year, were retrospectively reviewed. Visual and anatomical outcomes were evaluated at 3, 6, and 12 months. Complete polyp regression rate and percentage change of vascular lesion and polyp area were evaluated after three monthly injections of brolucizumab. The effect of complete polyp regression and the impact of vascular lesion and polyp reduction rate on 1-year treatment outcome were also evaluated. Results: In terms of visual outcome, best-corrected visual acuity significantly improved after 12-month follow-up (p < 0.001). In terms of anatomical outcome, central macular thickness (CMT) and central choroidal thickness significantly decreased after 12-month follow-up (p < 0.001). Complete polyp regression was observed in 23 patients (74.2%) after three monthly injections. Group with complete polyp regression had a higher rate of achieving dry macula at 3 months (p = 0.026) and fewer number of injections (p < 0.001) compared to the group without complete polyp regression. Higher polyp reduction rate was significantly associated with higher CMT change from baseline at 3 months (p = 0.048) while higher vascular lesion reduction rate was significantly associated with higher CMT change from baseline at 12 months (p = 0.031) and fewer number of injections (p = 0.012). Conclusions: Intravitreal brolucizumab injection effectively improved visual and anatomical outcomes and achieved significant polyp regression in treatment-naive PCV patients. Complete polyp regression and the reduction rate of vascular lesion size and polyp size after loading injection significantly influence the treatment outcome of PCV patients. However, careful monitoring and preoperative warning is warranted due to occurrence of brolucizumab-related IOI.
참고문헌 (33)
- Yannuzzi LA, "Idiopathic polypoidal choroidal vasculopathy (IPCV). 1990", Retina, 32(Suppl 1), pp.1~8 (2012)
- Cheung CM, "Polypoidal choroidal vasculopathy : consensus nomenclature and non-indocyanine green angiograph diagnostic criteria from the Asia-Pacific Ocular Imaging Society PCV Workgroup", Ophthalmology, 128, pp.443~452 (2021)
- Sho K, "Polypoidal choroidal vasculopathy: incidence, demographic features, and clinical characteristics", Arch Ophthalmol, 121, pp.1392~1396 (2003)
- Mori K, "Phenotype and genotype characteristics of age-related macular degeneration in a Japanese population", Ophthalmology, 117, pp.928~938 (2010)
- Bae K, "Angiographic subtypes of neovascular age-related macular degeneration in Korean : a new diagnostic challenge", Sci Rep, 9, pp.9701~ (2019)
- Byeon SH, "Incidence and clinical patterns of polypoidal choroidal vasculopathy in Korean patients", Jpn J Ophthalmol, 52, pp.57~62 (2008)
- Song SJ, "Age-related macular degeneration in a screened South Korean population: prevalence, risk factors, and subtypes", Ophthalmic Epidemiol, 16, pp.304~310 (2009)
- Uyama M, "Polypoidal choroidal vasculopathy : natural history", Am J Ophthalmol, 133, pp.639~648 (2002)
- Markham A, "Brolucizumab : first approval", Drugs, 79, pp.1997~2000 (2019)
- Nguyen QD, "Brolucizumab : evolution through preclinical and clinical studies and the implications for the management of neovascular age-related macular degeneration", Ophthalmology, 127, pp.963~976 (2020)
- Dugel PU, "HAWK and HARRIER:phase 3, multicenter, randomized, double-masked trials of brolucizumab for neovascular age-related macular degeneration", Ophthalmology, 127, pp.72~84 (2020)
- Dugel PU, "HAWK and HARRIER : ninety-six-week outcomes from the phase 3 trials of brolucizumab for neovascular age-related macular degeneration", Ophthalmology, 128, pp.89~99 (2021)
- Bodaghi B, "Detection and management of intraocular inflammation after brolucizumab treatment for neovascular age-related macular degeneration", Ophthalmol Retina, 7, pp.879~891 (2023)
- Kim JY, "Recurrence and visual prognostic factors of polypoidal choroidal vasculopathy : 5-year results", Sci Rep, 11, pp.21572~ (2021)
- Sayanagi K, "Effect of polyp regression and reduction on treatment efficacy in polypoidal choroidal vasculopathy treated with aflibercept", Sci Rep, 14, pp.1833~ (2024)
- Wong IY, "1-year results of combined half-dose photodynamic therapy and ranibizumab for polypoidal choroidal vasculopathy", BMC Ophthalmol, 15, pp.66~ (2015)
- Cho HJ, "Factors associated with polyp regression after intravitreal ranibizumab injections for polypoidal choroidal vasculopathy", Jpn J Ophthalmol, 59, pp.29~35 (2015)
- Ito A, "One-year outcomes of intravitreal brolucizumab injections in patients with polypoidal choroidal vasculopathy", Sci Rep, 12, pp.7987~ (2022)
- Cho HJ, "Intravitreal brolucizumab and aflibercept for polypoidal choroidal vasculopathy", J Ocul Pharmacol Ther, 39, pp.653~660 (2023)
- Fukuda Y, "Comparison of one-year outcomes between as-needed brolucizumab and aflibercept for polypoidal choroidal vasculopathy", Jpn J Ophthalmol, 67, pp.402~409 (2023)
- Chang YC, "Difference between pachychoroid and nonpachychoroid polypoidal choroidal vasculopathy and their response to anti-vascular endothelial growth factor therapy", Retina, 40, pp.1403~1411 (2020)
- Kim H, "Subfoveal choroidal thickness as a predictor of treatment response to anti-vascular endothelial growth factor therapy for polypoidal choroidal vasculopathy", Graefes Arch Clin Exp Ophthalmol, 254, pp.1497~1503 (2016)
- Matsumoto H, "Short-term outcomes of intravitreal brolucizumab for treatment-naïve neovascular age-related macular degeneration with type 1choroidal neovascularization including polypoidal choroidal vasculopathy", Sci Rep, 11, pp.6759~ (2021)
- Morimoto M, "Twoyear results of a treat-and-extend regimen with aflibercept for polypoidal choroidal vasculopathy", Graefes Arch Clin Exp Ophthalmol, 255, pp.1891~1897 (2017)
- Gomi F, "Initial versus delayed photodynamic therapy in combination with ranibizumab for treatment of polypoidal choroidal vasculopathy : the Fujisan Study", Retina, 35, pp.1569~1576 (2015)
- Ogura Y, "Efficacy and safety of intravitreal aflibercept injection in wet age-related macular degeneration : outcomes in the Japanese subgroup of the VIEW 2 study", Br J Ophthalmol, 99, pp.92~97 (2015)
- Koh A, "Efficacy and safety of ranibizumab with or without verteporfin photodynamic therapy for polypoidal choroidal vasculopathy : a randomized clinical trial", JAMA Ophthalmol, 135, pp.1206~1213 (2017)
- Kikushima W, "Comparison of initial treatment between 3-monthly intravitreal aflibercept monotherapy and combined photodynamic therapy with single intravitreal aflibercept for polypoidal choroidal vasculopathy", Graefes Arch Clin Exp Ophthalmol, 255, pp.311~316 (2017)
- Tanaka K, "Short-term results for brolucizumab in treatment-naive neovascular age-related macular degeneration : a Japanese multicenter study", Jpn J Ophthalmol, 66, pp.379~385 (2022)
- Fukuda Y, "Comparison of outcomes between 3 monthly brolucizumab and aflibercept injections for polypoidal choroidal vasculopathy", Biomedicines, 9, pp.1164~ (2021)
- Matsumoto H, "One-year results of treat-and-extend regimen with intravitreal brolucizumab for treatment-naive neovascular age-related macular degeneration with type 1 macular neovascularization", Sci Rep, 12, pp.8195~ (2022)
- Morizane-Hosokawa M, "Impact of polyp regression on 2-year outcomes of intravitreal aflibercept injections : a treat-and-extend regimen for polypoidal choroidal vasculopathy", Acta Med Okayama, 72, pp.379~385 (2018)
- Tsujikawa A, "Association of lesion size and visual prognosis to polypoidal choroidal vasculopathy", Am J Ophthalmol, 151, pp.961~972 (2011)