Most retinal vasculitis, vascular occlusion events after brolucizumab occurred in women
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Key takeaways:
- A literature search identified 70 eyes with retinal vasculitis or vascular occlusion following brolucizumab for wet age-related macular degeneration.
- Twenty of 42 eyes experienced vision loss.
A systematic review of real-world evidence described 70 eyes of 63 patients with retinal vasculitis or vascular occlusion following treatment with brolucizumab for neovascular age-related macular degeneration.
Approximately half of these events occurred after one injection, and more than one-third were the cause of reduced vision. Two-thirds of the cases were in women.
“Brolucizumab is a remarkably powerful anti-VEGF agent, and while it is not commonly utilized in clinical practice due to known risks of intraocular inflammation, retinal vasculitis and retinal vascular occlusions, it is still being used to treat some eyes with exudative retinal diseases globally,” study author Charles C. Wykoff, MD, PhD, told Healio. “In this work, we summarized data from existing literature reporting the most significant adverse events associated with brolucizumab, with the goal of better understanding the nature of these events, how patients were managed and how patients respond to treatment.”
The literature search focused on cases published in the Embase and Medline databases between January 2019 and June 2021. Nineteen publications met the inclusion criteria and described cases from the United States, Germany, Japan, Canada and India. A total of 63 cases involving 70 eyes, including seven bilateral cases, were reported, with a mean patient age of 77.6 years (range, 52 to 94 years) and a higher occurrence in women (77.8%). Occlusive retinal vasculitis accounted for 78.6% of events. Only two of the events did not have concurrent intraocular inflammation.
The mean number of brolucizumab injections before the event was 1.7, with 32 eyes (45.7%) receiving one injection, 27 eyes (38.6%) receiving two injections and 11 eyes (15.7%) receiving three injections. The mean time between the last injection and the event was 19.4 days, and 87.5% of events occurred within 30 days.
Of the 42 eyes with available pre-event and post-event data, 22 eyes (52.4%) had no loss or improvement of visual acuity, while 20 eyes (47.6%) had reduced vision. In 15 eyes (37.5%), vision loss was equal to or more than 0.30 logMAR (15 letters). Cases with no vision loss were slightly younger and had a higher rate of nonocclusive events.
“This information may prove useful in increasing our understanding of these events and their management in routine clinical practice,” the authors wrote.
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