Kim Jinsoo, Park Min Seon, Cho Bum-Joo, Kwon Soonil
Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, Gyeonggi, 14068, Republic of Korea.
Ophthalmol Ther. 2024 Oct;13(10):2789-2797. doi: 10.1007/s40123-024-01022-w. Epub 2024 Aug 30.
The aim of this study was to evaluate the efficacy and safety of escalating the dosage of intravitreal brolucizumab in patients with refractory neovascular age-related macular degeneration (AMD).
This retrospective study included 17 eyes of 17 patients with refractory AMD treated with high-dose brolucizumab (12 mg/0.1 ml) for over 12 months. Patients initially received at least one anti-vascular endothelial growth factor (anti-VEGF) agent and were switched to standard-dose brolucizumab (6 mg/0.05 ml). Those who showed a suboptimal response to standard-dose treatment had their dosage of brolucizumab escalated.
Visual acuity was maintained from 68.3 ± 3.4 letters to 70.7 ± 3.2 letters after 12 months of high-dose treatment (P = 0.128). Central subfield thickness was 343.7 ± 17.0 μm before high-dose treatment and 316.7 ± 18.5 μm at 12 months (P = 0.083). The proportions of patients with subretinal fluid and serous pigment epithelial detachment significantly decreased from 82.4% to 41.2% and from 52.9% to 17.6%, respectively, after high-dose treatment (P = 0.039 and P = 0.031, respectively). The treatment interval extended from 7.2 ± 2.4 weeks to 10.2 ± 2.2 weeks after switching to standard-dose brolucizumab (P < 0.001) and was maintained at 13.5 ± 2.8 weeks after increasing the dose (P = 0.154). No severe ocular adverse events were observed.
High-dose brolucizumab was effective in patients who did not respond to standard-dose brolucizumab after switching from previous anti-VEGF agents. Increasing the dosage could offer sustained disease control and reduce the treatment burden for patients with refractory AMD.
本研究旨在评估递增玻璃体内注射布罗芦izumab剂量对难治性新生血管性年龄相关性黄斑变性（AMD）患者的疗效和安全性。
本回顾性研究纳入了17例难治性AMD患者的17只眼，这些患者接受高剂量布罗芦izumab（12毫克/0.1毫升）治疗超过12个月。患者最初至少接受过一种抗血管内皮生长因子（抗VEGF）药物治疗，之后改用标准剂量布罗芦izumab（6毫克/0.05毫升）。对标准剂量治疗反应欠佳的患者，其布罗芦izumab剂量递增。
高剂量治疗12个月后，视力从68.3±3.4个字母维持到70.7±3.2个字母（P = 0.128）。高剂量治疗前中心子野厚度为343.7±17.0微米，12个月时为316.7±18.5微米（P = 0.083）。高剂量治疗后，视网膜下液和浆液性色素上皮脱离患者的比例分别从82.4%显著降至41.2%，从52.9%降至17.6%（P分别为0.039和0.031）。改用标准剂量布罗芦izumab后，治疗间隔从7.2±2.4周延长至10.2±2.2周（P < 0.001），剂量增加后维持在13.5±2.8周（P = 0.154）。未观察到严重眼部不良事件。
高剂量布罗芦izumab对从先前抗VEGF药物转换后对标准剂量布罗芦izumab无反应的患者有效。增加剂量可为难治性AMD患者提供持续的疾病控制并减轻治疗负担。
