Real-World Frequency and Management of Ocular Adverse Events in Eyes with Neovascular Age-Related Macular Degeneration Treated with Brolucizumab

Ryan Zubricky; Jasmyne McCoy; Richard Donkor; David G Miller; Nina Sonbolian; Andrew Heaney; Ver Bilano; Helene Karcher; Joseph M Coney

doi:10.1007/s40123-023-00741-w

Real-World Frequency and Management of Ocular Adverse Events in Eyes with Neovascular Age-Related Macular Degeneration Treated with Brolucizumab

Ophthalmol Ther. 2023 Oct;12(5):2397-2408. doi: 10.1007/s40123-023-00741-w. Epub 2023 Jun 13.

Authors

Ryan Zubricky¹, Jasmyne McCoy², Richard Donkor², David G Miller², Nina Sonbolian³, Andrew Heaney³, Ver Bilano³, Helene Karcher³, Joseph M Coney⁴

Affiliations

¹ Geisinger Eye Institute, Danville, PA, USA.
² Retina Associates of Cleveland Inc, 24075 Commerce Park, Beachwood, OH, 44122, USA.
³ Novartis Pharma AG, Basel, Switzerland.
⁴ Retina Associates of Cleveland Inc, 24075 Commerce Park, Beachwood, OH, 44122, USA. jconey@retina-assoc.com.

Abstract

Introduction: Intraocular inflammation (IOI)-related adverse events (AEs) that may result in severe vision loss have been associated with the anti-vascular endothelial growth factor brolucizumab. In this study, we investigate the timing, management and resolution of IOI-related AEs in a large cohort of patients treated with at least one injection of brolucizumab in routine clinical practice.

Methods: Retrospective review of medical records from patients with neovascular age-related macular degeneration treated with ≥ 1 brolucizumab injection between October 2019 and November 2021 at the Retina Associates of Cleveland, Inc. clinics.

Results: Of the 482 eyes included in the study, IOI-related AEs occurred in 22 (4.6%) eyes. Four (0.8%) eyes developed retinal vasculitis (RV) and of these, 2 (0.4%) had concomitant retinal vascular occlusion (RO). Most eyes [14/22 (64%)] developed the AE within 3 months and 4/22 (18%) within 3-6 months of the first brolucizumab injection. The median [interquartile range (IQR)] time from the last brolucizumab injection to development of the IOI-related AE was 13 (4-34) days. At the time of event, 3 (0.6%) eyes with IOI (no RV/RO) developed severe vision loss of ≥ 30 ETDRS letters, and a further 5 (1.0%) eyes (1 with IOI + RV, 1 with IOI + RV + RO) developed moderate vision loss of ≥ 15 letters compared with their last visual acuity (VA) prior to the AE. The median (IQR) vision loss was -6.8 (-19.9, -0.0) letters. Taking the best VA at either 3 or 6 months after AE resolution (or stability for occlusive events), VA decreased by ≥ 5 letters compared with prior to the AE in 3 (14%) of the 22 affected eyes, and was preserved (< 5-letter loss) in 18 (82%) eyes.

Conclusions: In this real-world study, most IOI-related AEs occurred early after brolucizumab treatment initiation. With appropriate monitoring and management of IOI-related AEs, vision loss associated with brolucizumab may be limited.

Keywords: Brolucizumab; Intraocular inflammation; Neovascular age-related macular degeneration; Retinal vascular occlusion; Retinal vasculitis; nAMD.