Treatment-Resistant AMD Manageable at Longer Dosing Intervals With Faricimab

Treatment-resistant neovascular age-related macular degeneration (nAMD) appears to respond to intravitreal faricimab, according to a report published in Clinical Ophthalmology. Patients who underwent the injections experienced improved vision and reduced central subfield thicknesses (CST) , as well as a mean last dosing interval longer than with aflibercept or ranibizumab, the reports shows .

Investigators examined records of 190 eyes of 186 patients (mean age, 80.1±8.1 years), all of whom had prior treatment with an anti-vascular endothelial growth factor (anti-VEGF) agent — an average of approximately 34 injections across 182 weeks before changing to faricimab. Participants received at least 3 faricimab doses and 3 months of follow-up, February 2022 to August 2022. No idiopathic intraocular inflammation occurred.

After an average of 6.99±2.3 injections and follow-up time of 34.88±8.2 weeks, best-corrected visual acuity (BCVA) improved from 0.33±0.32 logMAR to 0.27±0.32 logMAR (P =.0022), and CST from 312±87 to 287±71 µm (P <.0001).

Even patients with previously reported treatment-resistant AMD demonstrated improvements, and 24% of them displayed no subretinal or intraretinal fluid on optical coherence tomography (OCT) imaging — higher than the 17% noted in the Comparison of Age-related Macular Degeneration Treatments Trials: Lucentis-Avastin Trial (CATT, ClinicalTrials.gov Identifier: NCT00593450). Mean interval of the last 2 consecutive injections, previously 5.16 weeks with ranibizumab, or 5.57 weeks using aflibercept lengthened to 7.64 weeks with faricimab (both P <.0001). Previous treatment interval with bevacizumab averaged 4.68 weeks, and brolucizumab 6.18 weeks.

“The risk of endophthalmitis underscores the importance of trying to decrease the number of injections whenever possible,” researchers wrote. “Fortunately, the dosing interval was able to be extended further with faricimab, even in patients who did not tolerate longer injection intervals with ranibizumab or aflibercept.”

Current vision and CST results more closely resemble those demonstrated for ranibizumab and bevacizumab during 5-year follow-up research than in faricimab phase 3 data, possibly due to early gains in treatment-naïve clinical trial populations. In a small real-world study including both those untreated and patients already managed for nAMD, faricimab improved vision and fluid.

“Some patients may be poorly responsive or non-responsive to anti-VEGFs, with less than 25% reductions in central retinal thicknesses, persistent or new fluid or hemorrhages, and minimal visual improvements or even vision loss,” according to the study. Drug therapies may be switched in eyes with treatment-resistant AMD, the study authors add.

A short follow-up period, and a cohort size smaller than needed to comprehensively evaluate intraocular inflammation risk limited this investigation, as well as using only treat and extend regimen. Participants were not refracted.

Disclosure: Some study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.