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Brolucizumab: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on Oct 23, 2020.

1. How it works

  • Brolucizumab (also called brolucizumab-dbll) is an injectable eye preparation that may be used to treat an eye condition called neovascular (wet) age-related macular degeneration (AMD). It may also be known as exudative AMD.
  • Neovascular (wet) AMD is caused by abnormal blood vessel growth in the choriocapillaris, one of the layers of the eye that supply blood to the outer retina. It usually follows the dry form of AMD. Brolucizumab works by blocking the effects of VEGF-A. VEGF-A is a protein that makes blood vessels grow, leaking fluid and blood into the retina, which damages the macula. Brolucizumab binds to the 3 major forms of VEGF-A, blocking its effects and slowing the growth of blood vessels, and reducing their permeability, which controls leakage and slows vision loss.
  • Brolucizumab belongs to the class of medicines called Vascular Endothelial Growth Factor (VEGF) Inhibitors.

2. Upsides

  • May be used to treat neovascular (wet) age-related macular degeneration (AMD), an eye condition that occurs in older adults.
  • Initially given once a month (every 25 to 31 days) for the first three doses, then once every 8 to 12 weeks thereafter, depending on response.
  • Brolucizumab is available under the brand (trade) name of Breovu.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Blurred or hazy vision, increased sensitivity to light, seeing floaters, or eye pain are the most common side effects reported with brolucizumab. Antibody development, conjunctivitis, arterial thromboembolism, hypersensitivity reactions, and other eye-related side effects have also been reported.
  • Intravitreal injections may be associated with endophthalmitis and retinal detachment. Monitor for and report any symptoms such as eye pain, redness of the eye, photophobia, or blurred vision.
  • Brolucizumab may cause increased intraocular pressure (IOP), both acutely (within 30 minutes) and over time. IOP should be monitored via tonometry and optic nerve head perfusion immediately following administration and any increases should be managed appropriately. • Cases of retinal vasculitis and/or retinal vascular occlusion have been reported with brolucizumab; usually associated with intraocular inflammation. Monitor any vision changes.
  • Brolucizumab is associated with an increased risk of arterial thromboembolic events (such as a stroke or heart attack).
  • Must be given by a qualified physician trained in the administration of injectable eye preparations. Brolucizumab is administered directly into the vitreous humor of the eye – this is a jelly-like fluid that fills the inside of the eye. The eye and the eyelids need to be anesthetized before the procedure.
  • Each vial should only be used for the treatment of a single eye. Allow the vial to reach room temperature and inspect for particles or discoloration (the solution should be clear to slightly opalescent and colorless to slightly brownish-yellow). Use the needle and filter provided. Refer to the product information for more details.
  • Brolucizumab should not be given to anybody who has had a previous reaction to it, with an eye infection, or whose eye is currently inflamed.
  • Brolucizumab needs to be protected from light and refrigerated at 36°F to 46°F (2°C to 8°C), but do not freeze. Unopened vials may be kept at 68°F to 77°F (20°C to 25°C) for up to 24 hours before use.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Brolucizumab is an injectable eye preparation that may be used to treat neovascular (wet) age-related macular degeneration (AMD). After an initial dosing period, it is given once every three months by a qualified physician and trials have shown it has similar effectiveness to other treatments for neovascular AMD. Most people report little or no pain during the administration of brolucizumab which takes around 10 to 15 minutes.

5. Tips

  • Brolucizumab is administered by a qualified physician by injection directly into the vitreous humor of the eye. This is a jelly-like fluid that fills the inside of the eye. This way of giving medicine is known as "intravitreal" which means "inside an eye".
  • Before giving the brolucizumab injection, your physician will anesthetize your eye and eyelids using drops, gel, or a small numbing injection so the brolucizumab injection won’t hurt. Povidone-iodine solution is usually used to clean around the eye and then an eyelid speculum may be used to keep the eyelids open during the procedure. While you look in a particular direction, the physician will inject the medicine through the white part of the eye with a very small needle. Although you may feel slight pressure, there is little or no pain during the procedure which takes around 10 to 15 minutes.
  • Brolucizumab is administered monthly for the first three months then 8 to 12 weekly thereafter.
  • Ring your doctor or seek urgent medical attention if you develop any side effects such as eye pain, redness of the eye, light sensitivity, seeing "floaters" in your vision, blurred vision, decreased vision, tunnel vision, or seeing halos around lights. Also, seek urgent medical attention if you experience sudden numbness or weakness or problems with your speech or balance.

6. Response and Effectiveness

  • Brolucizumab has shown similar effectiveness and safety to other agents used to treat neovascular AMD, such as aflibercept, with a possibly longer duration of effect. Brolucizumab was just as effective as aflibercept with regards to baseline best-corrected visual acuity gains and stability of BCVA over 96 weeks.
  • The average change in baseline BCVA with brolucizumab was 6.6 after 48 weeks and 5.9 after 96 weeks. 33.6% of patients gained visual acuity (more than 15 letters of BCVA) after 48 weeks and 34.2% gained visual acuity after 96 weeks.
  • Data from the phase III HAWK and HARRIER trials showed that about 50% of patients treated with brolucizumab could be maintained on 12 weekly dosings without requiring rescue treatments.

7. Interactions

There are currently no documented medicines that interact with brolucizumab, according to the product information.

You should refer to the prescribing information for brolucizumab for any updates or newly noted interactions.

References

Brolucizumab. Updated 08/2020 Drugs.com https://www.drugs.com/ppa/brolucizumab.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use brolucizumab only for the indication prescribed.

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