Faricimab Increases Fluid-Free Interval, Extends Dosing Interval in Patients With AMD

Faricimab was able to increase fluid-free intervals and extend dosing intervals in patients with age-related macular degeneration (AMD), according to a study published in Graefe’s Archive for Clinical and Experimental Ophthalmology. Patients in the study were those who had poor responses to anti–vascular endothelial growth factor (VEGF) drugs.

Blindness is the main result of AMD and prevalence is expected to increase through 2050. Intravitreal faricimab is an anti–angiopoietin-2 treatment that has been approved in Europe. Although there have been phase 3 clinical trials for the medication, all of the participants had been treatment naïve. This study aimed to assess the efficacy of intravitreal faricimab in patients with neovascular AMD (nAMD), with safety and durability also evaluated.

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Patients who were switched to intravitreal faricimab treatment between September and December 2022 were eligible for the observational study. Those who had poor imaging of their retina or had less than 20 weeks of follow-up were excluded. All patients were divided into 2 subgroups: a frequent flyers (FF) group whose maximal fluid-free injection interval was between 4 and 8 weeks and a poor responders (PR) group who had a fixed injection interval of 4 weeks. The time periods around injection were separated into T0, before the injection; T1, after loading dose; and T2, after the first extension at 8 weeks. All demographic data were collected, which included treatment history.

The maximal fluid-free interval between 2 injections when using faricimab was the primary outcome for the study. Spectral-domain optical coherence tomography (SD-OCT) and visual acuity (VA) parameters were used as secondary end points. Central subfield thickness (CST), macular volume, and pigment epithelial detachment were used as parameters in SD-OCT. All patients were given injections of 6 mg per month for 4 months. The interval was extended to 8 weeks if a patient had complete response at week 12. A disease activity assessment was performed at week 20.

There were 26 eyes from 26 patients that were included in this study, of which 15 were female (58%). The participants had a median (IQR) age of 82 (77-85) years when taking the first injection of faricimab. Follow-up was performed for a median of 30.2 (26.3-33.1) weeks.

A median of 6.0 (4-8) weeks passed before the maximum fluid-free interval between injections was reached, which was longer compared with before the switch to faricimab. The median maximum fluid-free interval was 6.0 (4-8) weeks in the PR eyes and the FF eyes, which was significantly longer for the PR eyes compared with before the switch (4.0 [4-4] weeks) but not significantly longer for the FF eyes.

There were no significant differences in VA throughout the study. However, macular volume at T1 (median, 2.15 mm³; IQR, 1.96-2.52) and T2 (median, 2.39 mm³; IQR, 1.95-2.55) were significantly lowered compared with T0 (median, 2.57 mm³; IQR, 2.28-2.77). T1 (median, 262 mm; IQR, 232-338) and T2 (median, 292 mm; IQR, 241-347) had a significantly lower CST compared with T0 (median, 357 mm; IQR, 294-390), although the CST was higher at T2 compared with T1.

A dry macular OCT scan was found in a higher number of eyes after switching to faricimab compared with those who had before the switch (100% vs 32%). The dry scan was achieved a median of 4.0 (4-4) weeks after the switch. A total of 12 eyes had a dry OCT macular scan compared with 13 who had a recurrence of macular exudation by T2.

There were some limitations to this study. There was a small sample size and short follow-up for the study. Analysis of multimodal imaging was not done during this study and would need to be addressed separately. Patients who switched from aflibercept or ranibizumab were not included in a separate analysis.

The researchers concluded that faricimab could be used to treat nAMD who had a suboptimal response to anti-VEGF treatments.

Reference

Grimaldi G, Cancian G, Rizzato A, et al. Intravitreal faricimab for neovascular age-related macular degeneration previously treated with traditional anti-VEGF compounds: a real-world prospective study. Graefes Arch Clin Exp Ophthalmol. Published online December 4, 2023. doi:10.1007/s00417-023-06319-3