Safety and Efficacy of Brolucizumab in the Treatment of Diabetic Macular Edema and Diabetic Retinopathy: A Systematic Review and Meta-Analysis

ABSTRACT

Purpose

To investigate the efficacy and safety of brolucizumab in diabetic macular edema (DME) and diabetic retinopathy (DR).

Methods

In this systematic review and meta-analysis, an electronic search was done to acquire all articles describing brolucizumab use in patients with DME and DR. The review was prospectively registered on PROSPERO (CRD42022382625). Collected articles were filtered through two stages by independent reviewers. Data were extracted from the included articles and then analyzed accordingly.

Results

Brolucizumab induced significant improvement in best-corrected visual acuity and was either better or non-inferior to other types of anti-VEGF (MD −0.64 mu, 95% CI [−1.15, −0.13], P = .01); the same observation was noted with regards to central subfield macular thickness (CSMT) (MD −138.6 mu, 95% CI [−151.9, −125.3], P = .00001). Brolucizumab was reported to be relatively safe for use in diabetic patients, with few adverse events observed, with a higher frequency of adverse events in relation to the 3 mg dose compared to the 6 mg dose.

Conclusion

Brolucizumab is a new drug that has potential advantages in efficacy over other anti-VEGF agents in the treatment of DME and DR. It showed significant improvement in BCVA and CSMT with the possibility of a lower dosing schedule compared to other agents. Although observed in low frequency, sight-threatening adverse effects appear to occur more frequently compared to other anti-VEGF agents. The main observed adverse event was retinal vasculitis which was seen more commonly with the 3 mg dose versus the 6 mg dose.

KEYWORDS:

• Anti-VEGF
• BOVU
• brolucizumab
• macular edema
• vascular endothelial growth factor

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ Contributions

Conceptualization: HAS, AA; Data curation: MJT, MTA, AA; Formal analysis: SI, LAS; Funding acquisition: HAS; Investigation: QAS, NA; Methodology: HAS, AGE, AA; Project administration: BA, AGE; Resources: MJT, MTA; Software; HAS, SI; Supervision: AGE, HAS, AA; Validation: MJT, MTA, AA; Visualization: LAS, NA; Roles/Writing - original draft: HAS, MJT, AGE, AA; Writing - review & editing: QAS, NA, HAS. All authors read and approved the final manuscript.

Availability of data and material

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Funding

Open Access funding provided by the Qatar National Library.