Brolucizumab

How it works

It binds vascular endothelial growth factor A, blocking its interaction with VEGF receptors and thereby suppressing the abnormal choroidal and retinal neovascularisation and vascular leakage.

Prescribing in practice

• Carries a recognised risk of intraocular inflammation, including retinal vasculitis and retinal vascular occlusion that can lead to severe, sometimes permanent, vision loss.
• Contraindicated in active or suspected ocular or periocular infection and in active intraocular inflammation; administer under strict aseptic technique.
• Endophthalmitis and a transient rise in intraocular pressure can occur following intravitreal injection.

Monitoring

Monitor intraocular pressure and perfusion immediately after injection and review patients for signs of intraocular inflammation, vasculitis or occlusion at follow-up.

Counselling the patient

• Seek urgent ophthalmology review for eye pain, increasing redness, new floaters, light sensitivity or any reduction in vision after injection.
• Treatment requires regular review with monitoring of the response to each course.
• Do not drive until any post-injection visual disturbance has resolved.

Evidence & guidelines

An MHRA Drug Safety Update has highlighted the risk of retinal vasculitis and retinal vascular occlusion with brolucizumab; manage according to current specialist guidance.