Impact of Brolucizumab on Choroidal Morphology in Neovascular AMD: Insights From a Comparative Study

Brolucizumab significantly impacts choroidal morphology in eyes affected by type 1 neovascular AMD, according to a study published in Scientific Reports.

“In this cross-sectional study, we examined the effect of different anti-VEGF drugs on choroidal anatomy in patients affected by neovascular AMD and type 1 MNV naïve,” wrote Giacomo Boscia, Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Piazza Giulio Cesare, in Bari, Italy, and coauthors.

The study compared the effects of aflibercept and brolucizumab on choroidal morphology in 73 eyes with type 1 macular neovascularization (MNV) due to exudative AMD. Both drugs were administered over three months, and outcomes such as choroidal vascularity index (CVI), sub-foveal choroidal thickness (SFCT), and central macular thickness (CMT) were measured before and after treatment. Significant SFCT reduction was observed in both groups, but only brolucizumab led to significant changes in choroidal remodeling (SCA, TCA, and CVI).

Both groups showed a significant reduction in SFCT during the T2 visit. The AG (study group) had an SFCT of 242.30 ± 101.87 at T1 and 225.92 ± 93.69 at T2 (P=.033), while the BG (control group) had an SFCT of 256.36 ± 181.67 at T1 and 235.63 ± 164.78 at T2 (P=.024). However, in the AG, none of the choroidal parameters (CVI, LCA, TCA, and SCA) showed significant changes (P >.05) after the LP. Conversely, patients who received brolucizumab loading showed an increase in CVI from 0.75 at T1 to 0.79 at T2 (P=.025) and a reduction in both TCA and SCA at T2 as compared to T1 (P=.021; P=.029, respectively). Although not statistically significant, there was an observed increase in LCA after brolucizumab LP injections (P >.05). It is important to note that these choroidal remodeling modifications were significant between the two groups (P <.05).

Statistical analysis showed that there were modifications in Best-Corrected Visual Acuity (BCVA) after undergoing a Laser Photocoagulation (LP) procedure in both groups (P<.05). In the AG, CMT was measured as 333 ± 99.37 μm at T1, which significantly reduced to 237.3 ± 37.65 μm (P=.009) at T2. Similarly, in the BG, we observed a significant decrease in CMT from 354.36 ± 82.77 at baseline to 272.72 ± 58.93 at T2 (P<.001). However, when comparing the BCVA and CMT analyses between the two groups, no significant changes were observed (P≥.05).

“We propose that, after brolucizumab therapy, a greater stromal transudation reabsorption occurs, resulting in stromal and total choroidal volume reduction and therefore an increase of CVI, in comparison with eyes treated with aflibercept,” concluded the study authors.

Reference

Boscia G, Pozharitskiy N, Grassi MO, et al. Choroidal remodeling following different anti-VEGF therapies in neovascular AMD. Sci Rep. 2024;14:1941. doi:10.1038/s41598-024-52315-w