Switching to Faricimab Improves nAMD Dryness, Reduces Treatment Burden

Andrei Szigiato, MD, BSc

Credit: LinkedIn

Patients with a history of anti-VEGF treatment for their neovascular age-related macular degeneration (nAMD) experienced improvements to their central subfield thickness (CST) and maximum pigment epithelial detachment (PED) height, and maintained visual acuity (VA), when treated with faricimab intravitreal (IV) injection (VABYSMO) over a mean 24 weeks.¹

In new data presented at the 127th Annual American Academy of Ophthalmology (AAO) Congress in San Francisco, California, a team of Cleveland Clinic Cole Eye Institute investigators observed clinical benefit as well as increased intervals in IV injections among patients with nAMD who were switched from a different anti-VEGF to faricimab.

Roche’s faricimab, an IV bispecific antibody angiopoietin-2 (Ang-2) and vascular endothelial growth factor A (VEGF-A) inhibitor, was approved as a first-of-its-kind treatment for patients with nAMD or diabetic macular edema (DME) in January 2022.² Its approval was on the basis of phase 3 trial data showing significant, non-inferior benefit to patients’ VA and best-corrected VA (BCVA) scores relative to 8-week doses anti-VEGF agent aflibercept, among patients with either nAMD or DME, over 1 year.

Carl Regillo, MD, Director of Retina Service, Wills Eye Hospital and investigator of the TENAYA and LUCERNE trials for faricimab in patients with nAMD, previously told HCPLive that the greatest benefit with the novel treatment may be its reduced treatment burden on patients.

“The bottom line is these studies show definitively that faricimab works as well as aflibercept in exudative control of nAMD and achieving the vision gains that are well maintained over time after the initial loading phase, but with less frequent treatment,“ Regillo told HCPLive at AA 2021. “Having something that's more durable or longer acting is simply more forgiving, if you will.”

In these new data presented at AAO 2023, investigators led by Andrei Szigiato, MD, BSc, an ophthalmologist with Montreal Sacred Heart Hospital, sought to analze the impact of switching to IV faricimab injection in patients with nAMD currently receiving anti-VEGF regimens at the Cole Eye Institute.¹ They conducted a retrospective, non-comparative cohort study of patient eyes with ≥2 prior anti-VEGF injections in the last 6 months, and 1 within the last 10 weeks, for nAMD.

The team assessed VA, CST, PED height and presence of both subretinal or intraretinal fluid (SRF, IRF) at baseline and following each faricimab injection. Their primary outcome was CST and presence of fluid following ≥3 injections.

Their final analysis included 126 eyes of 106 patients; they were followed up with for a mean of 24.3 weeks. A majority (n = 111) of eyes previously received aflibercept, for a mean treatment interval of every 5.6 weeks with any prior anti-VEGF.

Szigiato and colleagues reported reduced mean CST score in patients after their first faricimab dose versus baseline (266.8 vs 249.8; P = .02), that which persisted over the following 3 injections of faricimab (P = .01). They additionally reported a reduced mean PED height following the third dose of faricimab versus baseline (249.6 vs 206.9; P = .01).

Treatment burden was significantly impacted by switching to faricimab; treatment intervals widened from 5.6 mean weeks at baseline to 6.8 weeks after the third dose. Another 60% (n = 76) of patients reported an interval extension of >1 week.

Among the 11 (8.7%) of patients who switched back to their anti-VEGF regimen, 8 reported it was due to worsened or same efficacy with faricimab; the other 3 reported it was due to treatment complications. All patients who switched back resumed aflibercept treatment.

“In this cohort of VEGF inhibitor-resistant nAMD, IV faricimab had a significant drying effect in the short term,” investigators concluded.

References

1. ^{Szigiato A, Mohan N, Talcott KE, Mammo DA, et al. Short Term Outcomes of Faricimab in Patients with Neovascular Age Related Macular Degeneration on Prior anti-VEGF Therapy. Abstract presented at: American Academy of Ophthalmology Congress. San Francisco, CA. November 3 – 6, 2023.}
2. ^{Kunzmann K. FDA Approves Faricimab for Patients with Wet AMD or DME. HCPLive. Published January 28, 2022. https://www.hcplive.com/view/fda-approves-faricimab-patients-wet-amd-or-dme}