Brolucizumab: An evolution in treatment for neovascular age-related macular degeneration

Introduction: The treatment paradigm for neovascular age-related macular degeneration (nAMD) has had a profound shift over the past 15 years with the advent of anti-vascular endothelial growth factor (VEGF) agents. However, the ability to sustain optimal visual outcomes is challenging with disease chronicity and treatment burden. Brolucizumab, a single-chain antibody fragment targeting all isoforms of VEGF, is a new molecule with properties that allow for less frequent doses of anti-VEGF to be administered with low systemic exposure. Areas covered: The authors will provide a comprehensive review of the current literature and clinical trial data surrounding brolucizumab in the treatment of nAMD, while comparing it with other emerging therapies. Expert opinion: Brolucizumab is a novel anti-VEGF inhibitor, with Phase I, II, and III trial data indicating safety, tolerability, and efficacy for the treatment of nAMD when given 12-weekly. Precision dosing with brolicizumab may best achieve the opportunity for vision improvement and maintenance of vision gains, while potentially maintaining patients on manageable dosing intervals with disease stability, improved treatment adherence, and reduced burden.