Faricimab for Treatment-Resistant Diabetic Macular Edema

Abstract

Purpose: To assess the short-term outcomes in treatment-resistant diabetic macular edema (DME) patients changed from intravitreal aflibercept (IVA) to intravitreal faricimab (IVF).

Methods: A retrospective review was undertaken on DME subjects receiving IVA therapy at a single private practice. Patients were separated into study and control cohorts. Both study and control patients had received more than or equal to six IVA injections during the preceding 12 months, more than or equal to four IVA injections during the preceding 6 months, had a central macular thickness (CMT) on optical coherence tomography (OCT) of ≥300 µm, and had retinal fluid on OCT before cohort assignment. Study patients were switched to IVF and underwent three injections within 4 months, whereas control patients stayed on IVA during the same period and received three injections within 4 months.

Results: There were 51 patients analyzed. There were 37.5% (9/24) in the study group and 3.7% (1/27) in the control group who achieved a CMT of less than 300 µm without retinal fluid on OCT at the end of the 4-month study (p=0.001). There were 41.7% (10/24) in the study group and 11.1% (3/27) in the control group who had gained two or more lines of visual acuity at the end of the 4-month study (p=0.01).

Conclusion: For a significant minority, IVF can improve the short-term visual and anatomic outcomes in treatment-resistant DME patients formerly managed with IVA. Longer follow-up is needed to determine if such improvements can be preserved.

Keywords: diabetic macular edema; faricimab; recalcitrance; treatment-resistant.

Figure 1

A 66-yearold male with severe nonproliferative diabetic retinopathy and persistent macular edema following ten intravitreal aflibercept injections over 12 months. (A) The baseline optical coherence tomography image demonstrates substantial diabetic macular edema. The central macular thickness was 570 µm and the Snellen visual acuity was 20/70. (B) The optical coherence tomography image of the same patient after being switched to faricimab and undergoing three faricimab treatments. The central macular thickness had decreased to 359 µm and the Snellen visual acuity improved to 20/40.