Real-World Faricimab Study Shows Acuity, Central Retinal Thickness Improvements

Faricimab shows marked improvements for patients with neovascular age-related macular degeneration in central retinal thickness and visual acuity within 1 month of first treatment.

Real-world faricimab data shows the anti-vascular endothelial growth factor (VEGF) therapy can lead to significant improvements in both central retinal thickness (CRT) and best-corrected visual acuity (BCVA) within 1 month of first injection, according to research published in Eye. A majority of participants in the study also experienced complete resolution of subretinal fluid in the same timespan. 

Researchers conducted a retrospective case series analysis that included 11 eyes of 9 patients (median age, 75.44 years [range: 61 to 89]; 55.55% women) with neovascular age-related macular degeneration (nAMD). The real-world faricimab study included 8 patients who were switched to faricimab from a different anti-VEGF drug after undergoing a median of 8 (range 0–25) previous injections. The other 3 patients were treatment-naive. The researchers treated 4 eyes with a loading dose of 4 monthly faricimab injections and the other 7 using a treat and extend regimen from the start of treatment. All eyes underwent intravitreal injection with faricimab between May and November 2022 and were followed up with optical coherence tomography (OCT), ultra-widefield (UWF) and fundus autofluorescence (FAF), and visual exams. 

At the 1-month follow-up, researchers found 4 eyes (36.36%) gained at least 1 line of vision, 6 eyes (54.54%) remained stable, and 1 eye (9.09%) lost 1 line of vision. In addition, a complete resolution of SRF was observed in 6 out of 8 eyes (75%).

The maximum recommended interval in between faricimab intravitreal injections based on CTs is Q16 weeks and is thus significantly longer than that of a one-compound anti-VEGF such as brolucizumab, aflibercept or ranibizumab.

The treatment-naive eyes in this real-world faricimab study had a mean baseline BVCA of 0.33±0.29 logMAR, and a mean CRT of 874.67±510.86 μm. A month after their first faricimab injection, BCVA improved to 0.30±0.29 logMAR, and mean CRT improved to 536.04±36.15 μm for eyes switched to faricimab from a different anti-VEGF drug.

For the real-world faricimab trial patients who were switched from another anti-VEGF therapy, baseline acuity was 0.612±0.75 logMAR and baseline CRT was 256.16±12.98 μm. After 1 month, researchers report that both values significantly improved, to 0.387±0.54 logMAR, and 245.43±15.34 μm, respectively.

When combining the groups, average CRT at baseline was 565.41±391.38 μm, which improved significantly to 326.97±226.48 μm at 1 month, according to the investigators. Foveal thickness too decreased in this timeframe, from 236.41±74.32 μm at baseline to 153.69±35.40 μm 1 month after treatment. Additionally, 4 eyes (36.36%) gained at least 1 line of vision, 6 eyes (54.54%) remained stable, and 1 eye (9.09%) lost a line of vision. Mean BCVA for all patients in the real-world faricimab investigation significantly improved from  0.612±0.75 logMAR to 0.387±0.54 logMAR, and CRT values decreased to 245.43±15.34 μm to 256.16±12.98 μm.

Another 3 patients experienced resolution of drusenoid pigment epithelial detachments, 1 experienced resolution of intraretinal fluid, and 1 saw resolution of subretinal hemorrhaging.

“We observed promising outcomes for visual acuity, safety, and central retinal thickness in both naïve and previously treated patients after faricimab injections. In addition, faricimab was well tolerated in all eyes (11 eyes) and no adverse events were observed,” according to the investigators. “The maximum recommended interval in between faricimab intravitreal injections based on CTs is Q16 weeks and is thus significantly longer than that of a one-compound anti-VEGF such as brolucizumab, aflibercept or ranibizumab. Although CTs and real-world treatment efficacy have been studied extensively comparing ranibizumab and aflibercept, faricimab real-world results are not yet available.”

This study was limited by its retrospective nature, relatively small sample size, short follow-up, and low number of treatment naïve eyes.

References:

Stanga PE, Valentín-Bravo FJ, Stanga SEF, Reinstein UI, Pastor-Idoate S, Downes SM. Faricimab in neovascular AMD: first report of real-world outcomes in an independent retina clinic. Eye. Published online March 23, 2023. doi:10.1038/s41433-023-02505-z