Brolucizumab for treating diabetic macular oedema

Brolucizumab for treating diabetic macular oedema

NICE state that:

• Brolucizumab is recommended as an option for treating visual impairment due to diabetic macular oedema in adults, only if:
  • the eye has a central retinal thickness of 400 micrometres or more at the start of treatment
  • the company provides brolucizumab according to the commercial arrangement
• the NICE committee suggest that
  • "..Diabetic macular oedema is usually treated first with aflibercept or ranibizumab, which are already recommended by NICE for treating diabetic macular oedema if the eye has a central retinal thickness of 400 micrometres or more when treatment starts. Brolucizumab is another treatment option that works in a similar way...Evidence from clinical trials shows that brolucizumab is as effective as aflibercept. An indirect comparison of brolucizumab with ranibizumab also suggests similar clinical effectiveness, although this is uncertain."

Brolucizumab

• is a novel single-chain fragment variable (scFv) antibody that inhibits all isoforms of VEGF-A and prevents binding of this ligand to VEGFR-1 and VEGFR-2
• has been suggested to have more tissue penetration with 2.2 and 1.7 times higher exposure in neurosensory retina and retinal pigment epithelium (RPE) than bevacizumab and ranibizumab respectively (2)
• likely also has a more rapid elimination half-life which may partially offset the improved penetration (2)

Reference:

• NICE (August 2022). Brolucizumab for treating diabetic macular oedema
• Motevasseli T, Mohammadi S, Abdi F, Freeman WR. Side Effects of Brolucizumab. J Ophthalmic Vis Res. 2021 Oct 25;16(4):670-675