Expert opinions on benefit-risk profile and clinical use of brolucizumab

Brolucizumab is a next-generation anti-vascular endothelial growth factor (VEGF) agent for the treatment of neovascular age-related macular degeneration. It is highly potent and thus appropriate for those unresponsive to other anti-VEGF agents and those undertreated owing to the low adherence or the heavy burden of repeated injections. An expert panel of 10 retina specialists from Hong Kong and Germany convened in February 2021 to discuss the benefit-risk profile and clinical use of brolucizumab. Evidence suggests that brolucizumab provides comparable visual outcomes to aflibercept at a more relaxed injection schedule. Brolucizumab is superior to aflibercept in resolving intraretinal and subretinal fluids and decreasing disease activity. Brolucizumab is suitable for patients unresponsive to other anti-VEGF agents, especially for those with persistent intraretinal and subretinal fluids or disease activity. Injection intervals of brolucizumab can be extended to 8 to 12 weeks. However, brolucizumab has higher risk of adverse events such as intraocular inflammation, retinal vasculitis, and retinal occlusion, compared with aflibercept. Thus, regular monitoring for signs of intraocular inflammation and prompt management are important before and during treatment.