Consensus of Expert Recommendations for the Safe Administration of Brolucizumab in Neovascular Age-related Macular Degeneration

Abstract

Brolucizumab offers improved anatomical outcomes and extended dosing intervals compared to aflibercept, reducing treatment burden. However, postmarketing surveillance and real-world studies have highlighted safety concerns, including intraocular inflammation (IOI), retinal vasculitis, and retinal vascular occlusion, necessitating risk management strategies. To address these concerns, a comprehensive review of clinical trials, real-world data, and safety reports were conducted by an expert panel. This consensus report offers practical, evidence-based recommendations to ensure the safe administration of brolucizumab in patients with neovascular age-related macular degeneration (nAMD). The safety management of brolucizumab in patients with nAMD starts with selecting suitable patient profiles through thorough risk assessments. Educating patients about the risk of inflammation and its symptoms is important, as prompt recognition and early medical attention may help improve outcomes. Close monitoring with frequent follow-ups and the use of widefield fundus imaging or peripheral fundus examination are also necessary for early detection and management of complications. Effective management of IOI includes considering discontinuation of brolucizumab, alternative anti-vascular endothelial growth factor therapies, and corticosteroid treatments based on anatomical location and severity of IOI. Differentiating noninfectious IOI from infectious endophthalmitis is essential to ensure appropriate intervention and safeguard vision. In conclusion, this consensus recommendations emphasized the importance of the evidence-based and patient-centered stepwise approaches that should be considered when prescribing brolucizumab to patients with nAMD. This is not an absolute guideline, and the management should be adapted according to the ophthalmic conditions and the patients' opinions after thorough discussions.