What is brolucizumab used for and how does it work?

• Brolucizumab is an injectable eye preparation that may be used to treat neovascular (wet) age-related macular degeneration (AMD) or diabetic macular edema.
• Brolucizumab works by blocking the effects of VEGF-A, a protein that promotes the growth of blood vessels in the choriocapillaris. This slows the growth of abnormal capillaries and reduces their permeability which slows vision loss.

Brolucizumab is an injectable eye preparation that is given to treat a particular type of age-related macular degeneration (AMD) called neovascular (wet) AMD. It may also be used to treat diabetic macular edema (DME). DME is a leading cause of blindness in adults in developed countries.

Neovascular (wet) AMD is an advanced form of AMD where vision loss has occurred because of abnormal blood vessel growth in a part of the eye called the choriocapillaris which is a layer of capillaries immediately adjacent to Bruch's membrane, the innermost layer of the choroid. The medical term for this is choroidal neovascularization. Neovascular (wet) AMD is usually preceded by the dry form of AMD.

How does brolucizumab work?

Brolucizumab works by blocking a substance called vascular endothelial growth factor A (VEGF-A).

VEGF-A is a protein that makes blood vessels grow, leaking fluid and blood into the retina, which damages the macula. Brolucizumab binds to the 3 major forms of VEGF-A, blocking its effects and slowing the growth of blood vessels and reducing their permeability, which controls leakage and slows vision loss.

Brolucizumab belongs to the class of medicines called Vascular Endothelial Growth Factor (VEGF) Inhibitors.

How is brolucizumab given?

Brolucizumab is administered by a qualified physician by injection directly into the vitreous humor of the eye. This is a jelly-like fluid that fills the inside of the eye. This way of giving medicine is known as "intravitreal" which literally means "inside an eye".

Brolucizumab is initially given once a month (every 25 to 31 days) for the first three doses, then once every 8 to 12 weeks thereafter, depending on response.

Does brolucizumab hurt when it is given?

Before giving the brolucizumab injection, your physician will anesthetize your eye and eyelids using drops, gel, or a small numbing injection so the brolucizumab injection won’t hurt. Povidone-iodine solution is usually used to clean around your eye and then an eyelid speculum may be used to keep your eyelids open during the procedure.

While you look in a particular direction, the physician will inject the medicine through the white part of your eye using a very small needle. Although you may feel slight pressure, there is little or no pain during the procedure which takes around 10 to 15 minutes. .

What is age-related macular degeneration (AMD)?

AMD is the leading cause of severe, permanent vision loss in people over age 60 and happens when the small central portion of your retina, called the macula, wears down. There are two forms of AMD:

• Dry AMD: Yellow deposits, called drusen, are commonly present in the macula. As these get bigger and more numerous, they start to dim or distort vision, especially when reading. As the condition progresses the light-sensitive cells in your macula get thinner and eventually die. Blind spots may occur in the center of your vision or you may lose central vision
• Wet AMD: Caused by blood vessels growing abnormally from the choriocapillaris which leaks blood and fluid into the retina. This can distort vision, so straight lines look wavy. Blind spots and a loss of central vision may also occur. Eventually, a scar forms that leads to permanent loss of central vision.

What is diabetic macular edema (DME)?

Diabetic macular edema (DME) is a complication of diabetes caused by fluid accumulation in the macula (the central part of the retina) that can affect the fovea ( the central portion of the macula where where visual acuity is the highest). Vision loss from DME happens gradually and can make it impossible to focus clearly.