BEOVU Indications: Wet age-related macular degeneration
Brand Name: Beovu
Drug Name: Brolucizumab
Date of FDA Approval: 8th Oct 2019
Manufacturer: Novartis Pharmaceuticals [Ref]
BEOVU® (Brolucizumab-dbll) injection is a medication that has been recently approved by the FDA for the treatment of wet age-related macular degeneration (AMD).
It is one of the new molecules that block vascular endothelial growth factors, called anti-VEGF inhibitors. These drugs inhibit the formation of new blood vessels in the retina.
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Mechanism of action of Brolucizumab:
VEGF-A interacts with two types of receptors in the body, known as VEGFR-1 and VEGFR-2. These receptors are found on the surface of endothelial cells, which line the inside of blood vessels.
When VEGF-A binds to these receptors, it triggers a cascade of events that promote the growth of new blood vessels (neovascularization) and increase vascular permeability, allowing fluid to leak into the surrounding tissues.
Brolucizumab, the active ingredient in BEOVU®, works by binding to VEGF-A and preventing it from interacting with VEGFR-1 and VEGFR-2.
This blocks the signaling pathway that leads to endothelial cell proliferation and neovascularization, as well as the increase in vascular permeability. By inhibiting these processes, BEOVU® can help reduce the amount of fluid and blood that leaks into the retina, slowing the progression of wet AMD and preventing further vision loss.
BEOVU® is administered as an injection into the eye and is typically given on a regular schedule, such as every eight to twelve weeks. As with other anti-VEGF inhibitors, BEOVU® may have side effects, such as eye pain, inflammation, and infection.
Patients receiving this medication should be monitored closely for any signs of adverse reactions and should report any changes in their vision to their healthcare provider immediately.
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What is Age-related Macular Degeneration?
Age-related macular degeneration is one of the common causes of vision loss in older people. It is further classified as:
- Dry Macular Degeneration, and
- Wet Macular Degeneration
In the dry type of macular degeneration, the macula becomes thin and there is progressive vision loss. In the wet form, which is a more severe form, there are new blood vessel formations which along with the proteins leaking out of them result in rapidly progressive vision loss.
Because vascular growth factors are primarily responsible for their proliferation, the newer molecules that target these receptors are being commonly used to treat wet age-related macular degeneration.
Although age is one common cause of the wet type of macular degeneration, other causes include:
- Smoking
- Obesity
- Genetics
- Hypertension, and
- UV exposure
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VEGF Inhibitors:
There are different VEGF inhibitors in the market. Except for bevacizumab (Avastin) which is not licensed for the treatment of wet age-related macular degeneration, all the others have been approved for this indication.
Here is a list of the different VEGF inhibitors:
| Medication | Brand Name | FDA-approved Indications | Dosage | Injection Frequency | Cost |
| Ranibizumab | Lucentis | Wet AMD, diabetic retinopathy, macular edema | 0.5 mg | Every 4-8 weeks | Expensive |
| Bevacizumab | Avastin | Not FDA-approved for eye conditions (off-label use) | 1.25-2.5 mg | Every 4-6 weeks | Inexpensive |
| Aflibercept | Eylea | Wet AMD, diabetic retinopathy, macular edema | 2 mg | Every 4-8 weeks | Expensive |
| Conbercept | KH902 | Wet AMD (China only) | 0.5 mg | Every 4 weeks | Not available in the US |
All anti-VEGF inhibitors are used to treat eye conditions that involve abnormal blood vessel growth, such as wet AMD, diabetic retinopathy, and macular edema, and are administered as injections into the eye.
All VEGF inhibitors, when injected may have potential side effects, such as eye pain, inflammation, and infection.
Brand names, FDA-approved indications, dosages, injection frequencies, and costs vary among the medications. Bevacizumab is not FDA-approved for eye conditions, but it has been used off-label for the treatment of wet AMD and other eye conditions.
Conbercept is only approved for the treatment of wet AMD in China and is not available in the United States.
BEOVU (Brolucizumab) is a new addition to the class of VEGF inhibitors that is a highly selective and potent drug. It should be used with caution in patients with thromboembolic disease, eye infections and those at risk of retinal detachment, and patients with raised intraocular pressure.
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In Conclusion:
BEOVU (Brolucizumab) is indicated and FDA-approved for the treatment of wet age-related macular degeneration. It prevents neovascularization and vision loss in aged people.