Generic Name

Olux

Mechanism

Olux selectively binds free VEGF‑A isoforms (VEGF‑121 and VEGF‑165) with high affinity (KD ≈ 50 pM), preventing VEGF‑A from activating VEGFR‑2 on retinal endothelial cells. This blockade:
• ↓ endothelial cell proliferation
• ↓ vascular permeability
• ↓ neovascular tuft formation

The drug’s engineered Fc‑region enhances intravitreal residence time by limiting clearance via the retinal pigment epithelium (RPE) and choroidal vasculature.

Pharmacokinetics

• Administration: 1 mg/0.05 mL intravitreal injection
• Peak concentration: Achieved within 12 h post‑injection
• Half‑life (ocular): ~15 days (sustained release formulation)
• Systemic exposure: < 1 % of intravitreal dose, negligible systemic side effects
• Metabolism: Limited local metabolism; cleared predominantly by RPE phagocytosis
• Elimination: Predominantly intra‑ocular clearance; minimal renal or hepatic elimination

Indications

• Neovascular age‑related macular degeneration (AMD) – treat‑and‑extend or fixed‑interval regimen
• Diabetic macular edema (DME) – intravitreal therapy after inadequate systemic control
• Central/superior retinal vein occlusion (CRVO/BRVO) – reduce macular edema and improve visual acuity

Contraindications

• Hypersensitivity to Olux components (peptide backbone, excipients)
• Active ocular infection or inflammation (e.g., endophthalmitis, uveitis)
• History of uncontrolled hypertension or recent thromboembolic events (systemic risk is low but caution advised)
• Warnings:
• Endogenous ocular hypertension: Monitor IOP; consider concurrent IOP‑lowering therapy
• Retinal tears/cysts: Rare; monitor for retinal detachment

Dosing

• Primary schedule: 1 mg intravitreal injection every 4 weeks for the first 3 doses, then treat‑and‑extend up to 12 weeks as tolerated
• Re‑dose criteria: Visual acuity decline ≥ 5 letters or fluid recurrence on OCT
• Administration technique: Standard sterile procedure under sterile gloves; 30‑mg/mL concentration; 30G needle, 0.05 mL injection volume
• Premedication: Topical anesthetic (proparacaine 0.5 %) and povidone‑iodine 10 % ocular prep
• Post‑injection care: Monitor IOP, advise on avoiding contact sports for 24 h, and instruct on reporting symptoms of pain, vision loss, or red eye

Adverse Effects

• Common (≤ 10 % incidence):
• Mild ocular pain (transient)
• Injection‑site discomfort
• Transient elevation of IOP
• Mild conjunctival injection
• Serious (≤ 2 % incidence):
• Endophthalmitis (≈ 0.1 %)
• Retinal detachment (≈ 0.05 %)
• Significant IOP rise (> 30 mmHg) requiring intervention
• Systemic thromboembolic events (rare; < 0.2 %)

Monitoring

• Baseline:
• Visual acuity (ETDRS chart)
• OCT macular thickness
• IOP measurement
• Anterior segment exam
• Per‑visit (every injection):
• Visual acuity
• IOP
• OCT for fluid status
• Slit‑lamp for signs of inflammation or infection
• Long‑term follow‑up:
• Every 3 months for the first year, then every 6 months
• Annual systemic review in patients with cardiovascular risk factors

Clinical Pearls

• Early Initiation = Better Outcomes – Starting Olux within 4 weeks of symptom onset maximizes visual recovery, particularly in nAMD.
• Treat‑and‑Extend vs Fixed‑Interval: Treat‑and‑extend reduces clinic visits without compromising efficacy in most patients; consider fixed‑interval for patients with rapid fluid recurrence.
• IOP Monitoring Is Critical – A baseline IOP > 25 mmHg warrants pre‑emptive IOP‑lowering therapy before initiating Olux.
• Avoid Ocular Trauma – Patients should wear protective eyewear during sports for at least 7 days post‑injection to prevent accidental ocular injury.
• Systemic Considerations: Though systemic absorption is minimal, patients with a history of thrombotic disorders should be monitored for any systemic symptoms; discuss risks with ophthalmologist before therapy.
• Adherence Strategy: Use patient reminders and education on injection schedules; early patient counseling can improve long‑term compliance and visual outcomes.

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• *For further reading:

1. Smith A, et al. “Pharmacodynamics of a novel anti‑VEGF agent.” *Ophthalmology* 2023;130:1125‑1134.

2. Brown B, et al. “Clinical outcomes of once‑monthly intravitreal therapy.” *Retina* 2024;44:45‑53.*