Brolucizumab noninferior to aflibercept for diabetic macular edema

Key Takeaways

• A study suggests that brolucizimab (Beovu) may improve anatomical measures of diabetic macular edema with fewer injections than older anti-VEGF medications.
• The authors suggest that if the results of this study translate to reduced treatment burden in clinical practice, it may improve patient compliance and reduce healthcare expenditure.

Brolucizumab (Beovu) is an injectable medication that binds and inhibits vascular endothelial growth factor A (VEGF-A), a signal protein that promotes the growth of new blood vessels. Anti-VEGF eye injections reduce fluid buildup and help to preserve vision in patients with diabetic macular edema (DME). Beovu, which may allow longer treatment intervals, was approved by the FDA for the treatment of DME in 2022.

Beovu proved noninferior to the anti-VEGF drug aflibercept (Eylea) for visual outcomes among patients with diabetic macular edema (DME), a new analysis of the phase III KINGFISHER trial showed. In over 500 patients with DME, the best-corrected visual acuity changes from baseline at week 52 were similar with the two drugs, reported Andrés Emanuelli, MD, of the University of Puerto Rico School of Medicine in Arecibo, and colleagues. In addition, brolucizumab outperformed the older anti-VEGF drug in the proportion of eyes without subretinal and intraretinal fluid (41.6% vs 22.2%, respectively) and mean central subfield thickness change from baseline at week 52 (-237.8 μm vs -196.5 μm), which are anatomical measures of DME activity, they noted in JAMA Ophthalmology.

“Fewer injections to dryness may improve patient compliance and reduce healthcare expenditure, if this truly translates to reduced treatment burden in clinical practice,” the authors wrote. “Approximately 30% to 40% of patients have persistent DME despite frequent treatment with [the anti-VEGF drugs] aflibercept or ranibizumab [Lucentis]. Thus, there remains an unmet need in that improved drying with brolucizumab may be a clinical advantage.” However, the authors noted that the dosing regimen evaluated is not approved for brolucizumab based on a higher reported frequency of visual adverse events as observed in the MERLIN study in wet age-related macular degeneration.

Raj Maturi, MD, an ophthalmologist at the Indiana University School of Medicine in Indianapolis who was not involved in the present study, told MedPage Today that the more rapid drying with brolucizumab is “a huge deal,” especially in light of the fact that fluid may return and cause DME in the future since diabetes is a lifetime condition. However, he also noted that brolucizumab has higher rates of adverse effects than other anti-VEGF therapies, and he prefers to use it as a second-line therapy after other drugs such as aflibercept and bevacizumab (Avastin).

Edited by Miriam Kaplan, PhD

Source: Randy Dotinga, MedPage Today, November 17, 2023; see source article