Some Treatment-Resistant Diabetic Macular Edema May Respond to Faricimab

Intravitreal faricimab (IVF) treatments can improve visual and anatomic outcomes in the short term among a significant minority of patients with diabetic macular edema (DME) who were previously managed with intravitreal aflibercept (IVA), according to results of a study published in Clinical Ophthalmology.

Patients (N=51) with DME who received treatment at the Panhandle Eye Group in Texas between February and May 2022 were included in this retrospective case-controlled series. All patients had been receiving IVA injections during the preceding 6 months. Patients allocated to the intervention cohort received 3 IVF injections spanning 4 months (n=24) and the other patients continued to receive IVA (n=27). The primary outcomes were changes in central macular thickness (CMT) and best-corrected visual acuity (BCVA).

The intervention and control cohorts comprised 50.0% and 51.9% women, aged mean 61.0 and 62.9 years, 62.5% and 70.4% had phakic lenses, they had received 14.2 and 13.4 intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection prior to the study inclusion, CMT was 400.2 and 395.0 μm, and BCVA was 0.60 and 0.61 logMAR, respectively.

At month 4, CMT thinner than 300 μm was attained among 37.5% of the IVF and 3.7% of the IVA recipients (P =.001). The mean CMT had decreased to 340.2 μm among the IVF cohort (P <.001) and 374.7 μm among the IVA group (P =.19).

An improvement of 2 or more BCVA lines was achieved by 41.7% of the IVF and 11.1% of the IVA cohorts (P =.01). Overall, BCVA was 0.50 and 0.59 logMAR among the intervention and control cohorts, respectively.

“Switching DME patients resistant to treatment with aflibercept to faricimab may lead to better visual and anatomic outcomes in a statistically significant minority of patients, thereby potentially allowing longer periods between treatments when a real-world treat-and-extend regimen is employed. Further investigations into this topic are warranted in order to confirm our study’s results, especially with a greater follow-up interval,” study authors report.

The major limitations of this study were the small sample sizes and short follow-up duration.