Brolucizumab (Intravitreal)

How it works

It binds vascular endothelial growth factor A with high affinity, inhibiting receptor activation and thereby suppressing pathological choroidal neovascularisation, vascular leakage and macular oedema.

Prescribing in practice

• Brolucizumab carries a recognised risk of intraocular inflammation, including retinal vasculitis and retinal vascular occlusion that can cause severe sight loss, so any new eye inflammation must prompt urgent review and treatment discontinuation.
• It is contraindicated in active or suspected ocular/periocular infection and active intraocular inflammation, and requires strict aseptic injection technique to prevent endophthalmitis.
• A transient rise in intraocular pressure may follow injection; monitor optic nerve perfusion and pressure around the procedure.

Monitoring

Monitor intraocular pressure and optic nerve perfusion at injection and review closely for intraocular inflammation, retinal vasculitis or vascular occlusion, with optical coherence tomography and visual acuity at follow-up.

Counselling the patient

• Report eye pain, increasing redness, light sensitivity, floaters or any drop in vision urgently after injection.
• Attend all monitoring visits, as inflammation can develop in the weeks following treatment.
• Mild irritation immediately after injection is common and usually settles.

Evidence & guidelines

The HAWK and HARRIER trials established efficacy in neovascular AMD, but post-marketing safety surveillance prompted MHRA and manufacturer warnings about intraocular inflammation, retinal vasculitis and occlusion.