Switching to Faricimab Improved Short-Term Outcomes in nAMD, Study Finds

Sumit Sharma, MD

Credit: Cleveland Clinic

A switch to faricimab therapy was associated with reductions in both mean central subfield thickness (CST) and maximum pigment epithelial detachment (PED) after 3 injections in eyes with neovascular age-related macular degeneration (nAMD), according to new research.¹

The investigative team from the Cole Eye Institute, led by Sumit Sharma, MD, found patients treated with faricimab achieved these reductions at a similar treatment interval to prior anti-vascular endothelial growth factor (VEGF) therapy.

“The most common agent used prior to switching to intravitreal faricimab injection was aflibercept, and the mean treatment interval with any anti-VEGF of 5.6 ± 1.6 weeks prior to switching,” investigators wrote.

Despite its status as the standard of care for retinal diseases, many patients with nAMD experience treatment burden and suboptimal responses with anti-VEGF therapy. Approved by the US Food and Drug Administration (FDA) in January 2022, faricimab is a novel bi-specific agent for the treatment of nAMD and diabetic macular edema.² The therapy targets and inhibits 2 pathways involved in several vision-threatening diseases by neutralizing angiopoietin-2 (Ang-2) and vascular endothelial growth factor-A (VEGF-A).

The goal of this analysis by Sharma and colleagues was to investigate the effect of switching to faricimab in patients with nAMD already treated with an anti-VEGF agent. The population for the retrospective, non-comparative cohort study included those patients with nAMD who switched to faricimab at the Cleveland Clinic Cole Eye Institute.¹

Both the switch and administration schedule of intravitreal faricimab was by the discretion of the clinician. Visual acuity and macular optical coherence tomography (OCT) measures, including CST, maximum PED height, and the presence of subretinal (SRF) or intraretinal fluid (IRF) were assessed at baseline and following each injection.

The main outcome for the analysis was CST and the presence of IRF or SRF after at least 3 intravitreal faricimab injections. A total of 126 eyes of 106 eyes were included in the analysis and had a mean follow-up time of 24.3 ± 5.2 weeks.

Prior to the switch to intravitreal faricimab, the study population received either aflibercept (mean, 20.0 ± 18.4), bevacizumab (7±8.9), ranibizumab (1.9±8.5), or brolucizumab (0.3±1.6 injections). Most patients used aflibercept (87%).

Upon analysis, investigators found CST was reduced from baseline after the first intravitreal injection (266.8 ± 64.7 vs. 249.8 ± 58.6 µm; P = .02), which persisted over the 3 injections (P = .01). In addition, PED height was observed to have reduced after the 3rd intravitreal faricimab injection (249.6 ± 179.0 vs. 206.9 ± 130 µm; P = .01).

Sharma and colleagues noted the mean visual acuity (62.9 vs. 62.7 approximate ETDRS letters; P = .42) and the interval between injections was similar after the 3rd injection, compared to baseline (6.3 vs. 5.7 weeks; P = .16).

Of the study population, 11 eyes (8.7%) were switched back to their previous anti-VEGF, including 2 eyes (1.6%) from 1 patient with intraocular inflammation requiring the cessation of intravitreal faricimab injections. However, they identified no other adverse events from switching.

Overall, the switch to faricimab was associated with an -11.6µm and -44.2µm reduction in mean CST and PED height, respectively, after 3 injections of the therapy.

References

1. Szigiato A, Mohan N, Talcott KE, et al. Short-Term Outcomes of Faricimab in Patients with Neovascular Age Related Macular Degeneration on Prior anti-VEGF Therapy [published online ahead of print, 2023 Sep 4]. Ophthalmol Retina. 2023;S2468-6530(23)00437-2. doi:10.1016/j.oret.2023.08.018
2. Kunzmann K. FDA approves Faricimab for patients with wet AMD or DME. HCP Live. April 15, 2022. Accessed September 11, 2023. https://www.hcplive.com/view/fda-approves-faricimab-patients-wet-amd-or-dme.