The changing landscape for the management of patients with neovascular AMD: brolucizumab in clinical practice

Abstract

Untreated neovascular age-related macular degeneration (nAMD) can lead to severe and permanent visual impairment. The chronic nature of the disease can have a significant impact on patients' quality of life and an economic and time burden on medical retina (MR) services, with the care need outweighing the growth of resources that clinical services can access. The introduction of a new treatment into clinical services can be challenging, especially for services that are already under capacity constraints. Guidance for practical implementation is therefore helpful. Roundtable meetings, facilitated by Novartis UK, between a working group of MR experts with experience of leading and managing NHS retinal services in the intravitreal era were conducted between 2020 and 2021. These meetings explored various aspects and challenges of introducing a new anti-vascular endothelial growth factor (VEGF) therapy to the UK medical retina services. Provision of clear expert recommendations and practical guidance nationally, that can be adapted locally as required to support clinicians and healthcare professionals (HCPs), is valuable in supporting the introduction of a new anti-VEGF therapy within the NHS environment. The experts provide ophthalmologic HCPs with a collation of insights and recommendations to support the introduction and delivery of brolucizumab in their local service in the face of current and projected growth in demand for retina care.

Fig. 1. Disease activity at week 16 in HAWK and HARRIER.

Full analysis set; analysis conducted based on the efficacy/safety approach. *The 95% confidence interval (CI) for treatment difference, –13.2 to 0.3; P = 0.033. ^†95% CI for treatment difference, –17.1 to –3.5; P = 0.001. ^‡95% CI for treatment difference, –15.8 to –3.1; P = 0.002. One-sided P values versus aflibercept.

Fig. 2. Brolucizumab treatment framework for patients with nAMD.

*For further information see expert opinion for guidance. **Recommended dose is 6 mg brolucizumab (0.05 ml solution). BCVA best-corrected visual acuity; DA, disease activity, ETDRS early treatment diabetic retinopathy study, IOI intraocular inflammation, IOP intraocular pressure, nAMD neovascular age-related macular degeneration, OCT optical coherence tomography, RO retinal vascular occlusion, VA visual acuity. 1. Beovu SmPC. Available at: https://www.ema.europa.eu/en/documents/product-information/beovu-epar-product-information_en.pdf. Accessed February 2021; 2. NICE. TA672. Available at: https://www.nice.org.uk/guidance/TA672. Accessed February 2021; 3. RCOphth. AMD Services Commissioning Guidance Available at: https://www.rcophth.ac.uk/wp-content/uploads/2021/02/AMD-Commissioning-Guidance-Consultation.pdf. Accessed February 2021; 4. Zarbin M, et al. American Academy of Ophthalmology Annual Meeting, 13–15 November 2020; 5. German Society of Ophthalmology (Deutsche Ophthalmologische Gesellschaft, DOG); German Retina Society (Retinologische Gesellschaft e. V, RG); Professional Association of German Ophthalmologists (Berufsverband der Augenärzte Deutschlands e. V, BVA) Ophthalmologe 2021;118(Suppl 1):31–39.