Evaluation of cardiac parameters and other safety outcomes of brolucizumab treatment in patients with neovascular age-related macular degeneration

Nadia Zakaria, Nicolas Guerard, Andres Emanuelli, Pravin Dugel, Jen Watts, Melissa Liew, Margarita Gekkieva, Markus Hinder, Nadia Zakaria, Nicolas Guerard, Andres Emanuelli, Pravin Dugel, Jen Watts, Melissa Liew, Margarita Gekkieva, Markus Hinder

Abstract

This was a prospective, single-dose, single-arm, open-label, non-randomized, multicenter clinical study to determine cardiovascular safety after a single brolucizumab 6 mg intravitreal injection in neovascular age-related macular degeneration patients (N = 14). Electrocardiogram (ECG) data were collected at different time points using 12-lead Holter and standard ECG, and patients were followed up to 8 days (end of study) for any signs of ocular and non-ocular adverse events (AEs). No clinically meaningful changes were observed in cardiac parameters. No patient had a ≥30 msec change from baseline in heart rate-corrected QT using Fridericia's formula (QTcF), and no patient had a new QTcF value of ≥450 msec between 20 and 24 h after treatment. No deaths or serious AEs were reported during the study period. These results are in line with the absence of new cardiovascular safety signal based on the ECG recordings collected over the first year of the pivotal studies performed with brolucizumab in DME. Trial Registration: ClinicalTrials.gov identifier: NCT03954626.

Keywords: anti-VEGF; brolucizumab; cardiovascular; intravitreal; nAMD.

© 2022 The Authors. Pharmacology Research & Perspectives published by British Pharmacological Society and American Society for Pharmacology and Experimental Therapeutics and John Wiley & Sons Ltd.

References

    1. Schmidt‐Erfurth U, Chong V, Loewenstein A, et al. Guidelines for the management of neovascular age‐related macular degeneration by the European Society of Retina Specialists (EURETINA). Br J Ophthalmol. 2014;98(9):1144‐1167.
    1. Wong WL, Su X, Li X, et al. Global prevalence of age‐related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta‐analysis. Lancet Glob Health. 2014;2(2):e106‐e116.
    1. Brown DM, Michels M, Kaiser PK, Heier JS, Sy JP, Ianchulev T. Ranibizumab versus verteporfin photodynamic therapy for neovascular age‐related macular degeneration: two‐year results of the ANCHOR study. Ophthalmology. 2009;116(1):57‐65.e5.
    1. Heier JS, Brown DM, Chong V, et al. Intravitreal aflibercept (VEGF trap‐eye) in wet age‐related macular degeneration. Ophthalmology. 2012;119(12):2537‐2548.
    1. Rosenfeld PJ, Brown DM, Heier JS, et al. Ranibizumab for neovascular age‐related macular degeneration. N Engl J Med. 2006;355(14):1419‐1431.
    1. Simo R, Hernandez C. Intravitreous anti‐VEGF for diabetic retinopathy: hopes and fears for a new therapeutic strategy. Diabetologia. 2008;51(9):1574‐1580.
    1. Thulliez M, Angoulvant D, Le Lez ML, et al. Cardiovascular events and bleeding risk associated with intravitreal antivascular endothelial growth factor monoclonal antibodies: systematic review and meta‐analysis. JAMA Ophthalmol. 2014;132(11):1317‐1326.
    1. Thulliez M, Angoulvant D, Pisella P‐J, Bejan‐Angoulvant T. Overview of systematic reviews and meta‐analyses on systemic adverse events associated with intravitreal anti–vascular endothelial growth factor medication use. JAMA Ophthalmol. 2018;136(5):557‐566.
    1. Semeraro F, Morescalchi F, Duse S, Gambicorti E, Romano MR, Costagliola C. Systemic thromboembolic adverse events in patients treated with intravitreal anti‐VEGF drugs for neovascular age‐related macular degeneration: an overview. Expert Opin Drug Saf. 2014;13(6):785‐802.
    1. Dugel PU, Koh A, Ogura Y, et al. HAWK and HARRIER: phase 3, multicenter, randomized, double‐masked trials of brolucizumab for neovascular age‐related macular degeneration. Ophthalmology. 2020;127(1):72‐84.
    1. Dugel PU, Jaffe GJ, Sallstig P, et al. Brolucizumab versus aflibercept in participants with neovascular age‐related macular degeneration: a randomized trial. Ophthalmology. 2017;124(9):1296‐1304.
    1. Nguyen QD, Das A, Do DV, et al. Brolucizumab: evolution through preclinical and clinical studies and the implications for the management of neovascular age‐related macular degeneration. Ophthalmology. 2020;127(7):963‐976.
    1. Holz FG, Dugel PU, Weissgerber G, et al. Single‐chain antibody fragment VEGF inhibitor RTH258 for neovascular age‐related macular degeneration: a randomized controlled study. Ophthalmology. 2016;123(5):1080‐1089.
    1. FDA . BLA 761094 BEOVU (brolucizumab‐dbll) Injection CDER. Accessed 11 June, 2020.
    1. Malik M, Garnett CE, Zhang J. Thorough QT studies. Drug Saf. 2010;33(1):1‐14.
    1. Georgakopoulos CD, Pallikari A, Plotas P, et al. Effect of intravitreal injection of aflibercept on cardiovascular risk parameters in patients with neovascular age related macular degeneration. Curr Clin Pharmacol. 2020;137:483‐490.
    1. Dalvin LA, Starr MR, AbouChehade JE, et al. Association of intravitreal anti–vascular endothelial growth factor therapy with risk of stroke, myocardial infarction, and death in patients with exudative age‐related macular degeneration. JAMA Ophthalmol. 2019;137(5):483‐490.
    1. Starr MR, Dalvin LA, AbouChehade JE, et al. Classification of strokes in patients receiving intravitreal anti‐vascular endothelial growth factor. Ophthalmic Surg Lasers Imaging Retina. 2019;50(5):e140‐e157.
    1. Mladěnka P, Applová L, Patočka J, et al. Comprehensive review of cardiovascular toxicity of drugs and related agents. Med Res Rev. 2018;38(4):1332‐1403.
    1. Sharma A, Kumar N, Parachuri N, et al. Brolucizumab—early real‐world experience: BREW study. Eye. 2021;35(4):1045‐1047.
    1. Chakraborty D, Maiti A, Sheth JU, et al. Brolucizumab in neovascular age‐related macular degeneration‐Indian real‐world experience: the BRAILLE study. Clin Ophthalmol. 2021;15:3787.

Source: PubMed

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