Clinical features and associated factors of intraocular inflammation following intravitreal brolucizumab as switching therapy for neovascular age-related macular degeneration

Sotani, Rei; Matsumiya, Wataru; Kim, Kyung Woo; Miki, Akiko; Yasuda, Eriko; Maeda, Yoshifumi; Hara, Rumiko; Kusuhara, Sentaro; Nakamura, Makoto

doi:10.1007/s00417-023-06036-x

Cited by 4 publications

(5 citation statements)

References 35 publications

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“…Choroidal thinning caused by IVBr has also been reported [9][10][11][12][13]. However, to our knowledge, no reported cases exist of severe choroidal thinning caused by IOI after IVBr.…”

Section: Introductionmentioning

confidence: 80%

“…Several reports have documented IOI associated with brolucizumab, with reported frequencies ranging from 4.6 to 22.1% [2,[5][6][7][8][9][10][11]. According to reports, the Japanese may have a higher incidence of IOI [5,[7][8][9][10][11]. Most reported cases of IOI have focused on anterior chamber inflammation, retinal vasculitis, and retinal vascular occlusion, with no reports specifically addressing the choroid.…”

Section: Discussionmentioning

confidence: 99%

“…Here, we report a case of severe IOI and subsequent marked choroidal thinning following the initial IVBr. Several reports have documented IOI associated with brolucizumab, with reported frequencies ranging from 4.6 to 22.1% [2,[5][6][7][8][9][10][11]. According to reports, the Japanese may have a higher incidence of IOI [5,[7][8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…Brolucizumab is non-inferior to aflibercept for improving and maintaining visual acuity in eyes with nAMD and is more effective for intraretinal and subretinal fluid and subretinal pigment epithelium fluid [1,2]. However, cases of intraocular inflammation (IOI), such as uveitis and retinal vasculitis, have been reported with intravitreal brolucizumab injections (IVBr) [2][3][4][5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Marked Choroidal Thinning Observed after Intravitreal Brolucizumab Injection

Ueta,

Kamada,

Watanabe

et al. 2023

Case Rep Ophthalmol

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Introduction: Here, we report a case of severe intraocular inflammation (IOI) and prominent choroidal thinning following the initial intravitreal brolucizumab injection (IVBr). Case Presentation: The patient was a 75-year-old Japanese man with type 2 age-related macular degeneration of both eyes. Until 2015, he had undergone two intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections and two photodynamic therapies in his right eye. His decimal best-corrected visual acuity (BCVA) was 0.1 in the right eye and 0.1 in the left eye. Central choroidal thickness (CCT) measured 240 μm in his right eye. IVBr was administered to the right eye. The patient reported pain in the right eye 23 days after the injection. On day 26, panuveitis and retinal vasculitis were observed in the right eye. CCT measured 436 μm. On the same day, a sub-tenon triamcinolone injection was administered. On day 42, retinal inflammation remained at a similar level. The CCT decreased to 164 μm. On day 68, the intraocular pressure (IOP) in the right eye increased to 39 mm Hg, and IOI persisted. On day 89, the patient’s eye pain disappeared, and the IOP decreased to 13 mm Hg. On day 225, the IOI and symptoms were completely resolved. The decimal BCVA was 0.04 in the right eye, and CCT measured 84 μm. Conclusion: Brolucizumab is a highly effective anti-VEGF drug; however, it has the potential to induce inflammation in tissues adjacent to the retina and may occasionally cause irreversible sequelae.

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“…Choroidal thinning caused by IVBr has also been reported [9][10][11][12][13]. However, to our knowledge, no reported cases exist of severe choroidal thinning caused by IOI after IVBr.…”

Section: Introductionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Marked Choroidal Thinning Observed after Intravitreal Brolucizumab Injection

Ueta,

Kamada,

Watanabe

et al. 2023

Case Rep Ophthalmol

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“…29 Most eyes treated with brolucizumab in the real world were previously treated with other anti-VEGF agents. 16,17,[21][22][23]26,35,[39][40][41][42][43] It is possible that previously treated eyes are equally susceptible to IOI but somehow less susceptible to retinal vasculitis than treatment-naïve eyes.…”

Section: Safetymentioning

confidence: 99%

Efficacy, Safety, and Durability of Brolucizumab: An 8-Month Post-Marketing Surveillance Analysis

Saba,

Walter

2023

OPTH

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Importance Brolucizumab (Beovu ® ) is an anti-vascular endothelial growth factor (anti-VEGF) agent approved for the treatment of neovascular age-related macular degeneration (nvAMD). Brolucizumab was marketed for its noninferiority to aflibercept and its potential for greater durability. However, post-marketing utilization has been tempered by safety concerns. Objective We evaluate the visual and anatomic efficacy of brolucizumab, examine changes in treatment intervals after switching to brolucizumab, and estimate the incidence of drug-related adverse events in the real world. Design, Setting, and Participants This was a retrospective consecutive case series of 626 eyes (543 patients) with nvAMD treated with 1438 brolucizumab injections at a single retina practice between 10/1/2019 and 5/15/2020. Main Outcomes and Measures Changes in visual acuity (VA); anatomic outcomes assessed by optical coherence tomography (OCT) including central subfield thickness (CST), macular volume (MV), presence of intraretinal fluid (IRF), subretinal fluid (SRF), and serous pigment epithelial detachment (sPED) on foveal line scans; treatment intervals before and after receiving brolucizumab; and the incidence of brolucizumab-related adverse events. Results The majority of eyes (N = 531, 89.7%) had received prior anti-VEGF therapy with aflibercept, ranibizumab, and/or bevacizumab. VA improved in treatment-naïve eyes (+3.7 letters, p = 0.04), and was maintained in previously treated eyes. There were significant improvements in all anatomic outcomes in both groups (p < 0.001). We observed a 4.8% incidence of intraocular inflammation (IOI) and a 0.6% incidence of retinal vasculitis. The average treatment interval increased from 6.3 to 6.8 weeks (p = 0.001). Conclusions and Relevance Brolucizumab treatment was associated with VA improvement in naïve eyes and maintenance of VA in previously treated eyes. Switching to brolucizumab was associated with improved anatomic outcomes and extended treatment intervals in most eyes. We observed a similar incidence of IOI and a lower incidence of retinal vasculitis compared to the Safety Review Committee’s analysis of HAWK and HARRIER.

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Brolucizumab

2023

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Clinical features and associated factors of intraocular inflammation following intravitreal brolucizumab as switching therapy for neovascular age-related macular degeneration

Cited by 4 publications

References 35 publications

Marked Choroidal Thinning Observed after Intravitreal Brolucizumab Injection

Marked Choroidal Thinning Observed after Intravitreal Brolucizumab Injection

Efficacy, Safety, and Durability of Brolucizumab: An 8-Month Post-Marketing Surveillance Analysis

Brolucizumab

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