Brolucizumab - risk of intraocular inflammation and retinal vascular occlusion increased with short dosing intervals

• brolucizumab is a vascular endothelial growth factor (anti-VEGF) drug used in the treatment of neovascular age-related macular degeneration (nAMD) (1)
• brolucizumab
  • is a humanised monoclonal antibody indicated for the treatment of neovascular (wet) age-related macular degeneration (AMD)
  • recommended dose is 6mg brolucizumab by intravitreal injection every 4 weeks (monthly) for the first 3 doses
  • thereafter, maintenance treatment intervals should be individualised based on disease activity
  • in patients without disease activity, treatment every 12 weeks (3 months) should be considered.
  • in patients with disease activity, treatment every 8 weeks (2 months) should be considered.
  • intraocular inflammation, including retinal vasculitis, and retinal vascular occlusion are adverse drug reactions known to be associated with brolucizumab
• seems that brolucizumab has a place at least as a second-line anti-VEGF agent in patients with high treatment demand (1)
  • the increase in reading acuity seems to go along with an improved control of disease activity after switch to brolucizumab and may well contribute to an improved vision-related quality of life
  • given the risk of intraocular inflammation and vascular occlusion, careful patient selection and education remain essential for early detection and successful treatment of possible complications

Advice for healthcare professionals (2):

• intraocular inflammation, including retinal vasculitis, and retinal vascular occlusion are adverse drug reactions uncommonly associated with intravitreal injection of brolucizumab
• in patients who develop intraocular inflammation or retinal vascular occlusion, discontinue treatment with brolucizumab and manage events promptly
• to reduce the risk of these events, do not administer maintenance doses of brolucizumab (after the first 3 doses) at intervals of less than 8 weeks apart
• closely monitor patients treated with brolucizumab who have a medical history of intraocular inflammation or retinal vascular occlusion (within 12 months before the first brolucizumab injection) since they are at increased risk of developing these adverse reactions post-injection
• intraocular inflammation or retinal vascular occlusion may occur at any time during brolucizumab treatment but occur more frequently during early treatment
• based on observational studies, retinal vasculitis and retinal vascular occlusion after brolucizumab treatment appear to be more frequent in female patients and in patients of Japanese ancestry
• report any suspected adverse drug reactions associated with brolucizumab on a Yellow Card

Reference:

• Haensli C, Pfister IB, Garweg JG. Switching to Brolucizumab in Neovascular Age-Related Macular Degeneration Incompletely Responsive to Ranibizumab or Aflibercept: Real-Life 6 Month Outcomes. J Clin Med. 2021;10(12):2666. Published 2021 Jun 17. doi:10.3390/jcm10122666
• Drug Safety Update volume 15, issue 6: January 2022: 1.