Efficacy and safety of brolucizumab versus aflibercept in eyes with early persistent retinal fluid: 96-week outcomes from the HAWK and HARRIER studies

David R. Lally*, Anat Loewenstein, Jennifer J. Arnold, Yit C. Yang, Kinfemichael Gedif, Catherine Best, Hersh Patel, Ramin Tadayoni, Jeffrey S. Heier

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective: Post-hoc analysis to compare the outcomes of brolucizumab 6 mg vs. aflibercept 2 mg in neovascular age-related macular degeneration (nAMD) patients with early persistent retinal fluid in HAWK and HARRIER. Methods: After 3 monthly loading doses, brolucizumab-treated eyes (N = 730) received injections every 12 weeks (q12w) or q8w if disease activity was detected. Aflibercept-treated eyes (N = 729) received fixed q8w dosing. Early persistent fluid was defined as the presence of subretinal fluid and/or intraretinal fluid up to Week 12. Results: A lower proportion of brolucizumab patients had early persistent retinal fluid compared with aflibercept (11.2% (n = 82) vs. 19.2% (n = 140)). In these patients, 34.1% of the brolucizumab-treated group achieved a ≥ 15 ETDRS letter gain in best corrected visual acuity (BCVA) from baseline at Week 96 compared with 20.7% of the aflibercept-treated group. Brolucizumab achieved numerically better BCVA outcomes (Week 96: brolucizumab, +6.4 letters; aflibercept, +3.7 letters) and significantly greater central subfield thickness reductions versus aflibercept from baseline through Week 96 (Week 96: −202 µm vs. −145 µm; p = 0.0206). Brolucizumab demonstrated an overall favourable benefit/risk profile in this patient cohort. In their unmasked, post-hoc review, the Safety Review Committee identified two cases of retinal vasculitis and no cases of retinal vascular occlusion in the brolucizumab arm; no cases of retinal vasculitis or retinal vascular occlusion were identified in the aflibercept arm. Conclusion: In this analysis, anatomical and visual outcomes were better with brolucizumab compared with aflibercept. Brolucizumab may therefore achieve greater disease control than aflibercept in nAMD patients with early persistent retinal fluid.

Original languageEnglish
Pages (from-to)1242-1248
Number of pages7
Issue number6
StatePublished - Apr 2023


FundersFunder number
Alcon and Novartis
Alcon, Bausch and Lomb
Beyeonics Surgical
Consultant to Allergan
Novartis Ireland Ltd.
Janssen Research and Development
Five Colleges
Novartis Pharmaceuticals Corporation
Bayer Fund
Aldeyra Therapeutics
Bayer HealthCare


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