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. 2024 Oct 7:18:2821-2829.
doi: 10.2147/OPTH.S468458. eCollection 2024.

Evaluating Faricimab in Treatment-Naive Neovascular Age Related Macular Degeneration: A Retrospective Analysis of Real-World Data

Danielle Modeste  1 , Christopher Stewart  2 , Hajani Premanandhan  2 , Mahmoud Husseiny Awad  1 , Gwyn Samuel Williams  1
Affiliations

Evaluating Faricimab in Treatment-Naive Neovascular Age Related Macular Degeneration: A Retrospective Analysis of Real-World Data

Danielle Modeste et al. Clin Ophthalmol. .

Abstract

Purpose: To evaluate the efficiency and safety of Faricimab on treatment-naive neovascular age related macular degeneration (nAMD) in a real world UK clinic.

Patients and methods: This single centre, retrospective note review was conducted on treatment-naive patients with nAMD. The data collected included demographics, best corrected visual acuity (BCVA), central macular thickness (CMT), total retinal fluid (TRF), the presence of intraretinal fluid (IRF) and subretinal fluid (SRF).

Results: A total of 66 eyes from 62 patients were analysed. The average age was 77 years (range 36-91) and 54% of patients were female. After the first dose of faricimab, the average BCVA improved by 0.05 LogMAR (+2.5 letters), the average CMT decreased by 65.9μm and 41% of patients were found to be inactive. The follow-up intervals after the third loading dose were divided into 2 subsets of 4 and 8 week extensions. The 4 week extension subset saw a smaller improvement in BCVA (+3 letters) than the 8 week extension (+6 letters) while both had an average decrease in CMT by 86.6 μm. The total retinal fluid decreased by 45% and 70.7%, leaving only 30% and 12.2% residual intraretinal fluid (IRF) and 30% and 24.4% residual subretinal fluid (SRF), respectively. Over a ten-month period, the average number of injections received was 6.6, including 3 initial loading doses. There was only one reported case of an adverse event out of 66 eyes (1/66, 1.5%).

Conclusion: Three loading doses of Faricimab appear efficacious and safe for the treatment of nAMD.

Keywords: Faricimab; dosing interval; nAMD; treatment-naïve.

Plain language summary

What is already known on this topic: Faricimab is recombinant humanised bispecific IgG monoclonal antibody which binds and neutralises both VEGF-A and angiopoietin-2 (VEGFA and ANG2).Clinical trials have reported faricimab dosing intervals of up to Q16W. What this study adds: To offer a glimpse into real-world effectiveness and safety of faricimab beyond the constraints of a randomised controlled study in treatment naïve nAMD patients.Presents results derived from implementing a “Treat and Extend” algorithm with faricimab in nAMD management, showcasing its beneficial impact on the strategic planning and execution of patient care. How this research may affect research, practice or policy: Faricimab should be seen as a viable therapy in treatment-naive patients with nAMD.Employing a shortened loading regimen of three doses presents no discernible detriment to treatment efficacy when compared to the established four-dose schedule.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Treat and Extend algorithm and discharge guidelines for the use of Faricimab in neovascular age related macular degeneration n(AMD). Where ACTIVE CNV is defined by the presence of new or residual intraretinal and/or subretinal fluid and new haemorrhages, INACTIVE CNV is characterized by a dry macula, resolving old haemorrhage, and resolving intraretinal and subretinal fluid. Fluid that remains unchanged for 3 consecutive visits may be considered inactive and eligible for trial extension of the treatment interval.
Figure 2
Figure 2
Efficacy of Faricimab over the course of 3 loading injections. (A) Change in the best corrected visual acuity (BCVA), (B) Change in the central macular thickness (CMT), (C) Change in the percentage of total retinal fluid (TRF) present, (D) Change in the intraretinal fluid (IRF) and (E) Change in the subretinal fluid (SRF). Timeline: 1, baseline week 0; 2, 4 weeks following the 1st loading injection at week 4; 3, 4 weeks following the 2nd loading injection at week 8; At the extension phase: 4a, 4 weeks following the 3rd loading injection at week 12; 4b, 8 weeks following the 3rd injection at week 16. ***p<0.001, **p<0.01 compared to baseline.
Figure 3
Figure 3
Pie charts illustrating the treatment intervals determined by the (A) third, (B) fourth and (C) fifth Faricimab injections. Represented by percentages.
Figure 4
Figure 4
Graph depicting the total number and frequency of Faricimab injections received during the observed period.
See this image and copyright information in PMC

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