brolucizumab: clinical use

Prescribing considerations

• Administration is restricted to ophthalmologists experienced in intravitreal injection, using appropriate aseptic technique.
• Record the product name and batch number for biological-medicine traceability.
• Closely assess patients with intraocular inflammation or retinal vascular occlusion during the preceding year because recurrence risk is increased.
• Exercise caution with poorly controlled glaucoma, recent arterial thromboembolic events, retinal pigment epithelial tear risk factors, recent or planned intraocular surgery, or limited-evidence populations such as uncontrolled hypertension in diabetes.
• Discontinue brolucizumab and promptly manage intraocular inflammation, retinal vasculitis or retinal vascular occlusion.

Contraindications and cautions

• Hypersensitivity to brolucizumab or an excipient.
• Active or suspected ocular or periocular infection.
• Active intraocular inflammation.

Monitoring

• Assess visual acuity and retinal anatomy to establish disease activity and benefit.
• Monitor intraocular pressure and optic-nerve-head perfusion after injection.
• Monitor for endophthalmitis, intraocular inflammation, retinal vasculitis, retinal vascular occlusion, retinal tear or detachment and traumatic cataract.
• Educate patients to report pain, redness, photophobia, new floaters or deteriorating vision immediately.
• Report suspected adverse reactions through the Yellow Card scheme, including brand and batch information where available.

Clinical pharmacology

Brolucizumab is a humanised single-chain antibody fragment that binds VEGF-A isoforms and prevents activation of VEGFR-1 and VEGFR-2. It acts locally within the eye to reduce pathological neovascularisation and vascular permeability; systemic exposure after intravitreal administration is low.

Formulation and product differences

• The selected product is a sterile, single-use pre-filled syringe solution intended for one eye only.
• The syringe contains excess solution that must be expelled before administration; injecting its entire contents could cause overdose.
• The solution contains polysorbate 80, which may cause allergic reactions, and is essentially sodium-free.
• Do not use a syringe that is damaged, expired, cloudy or contains visible particles.

Injection

Route: Parenteral

Strengths: 120 mg/mL