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Published on: August 11, 2023
Therapeutic effects of faricimab on aflibercept-refractory age-related macular degeneration
Ryosuke Tamiya1, Masayuki Hata2, Asako Tanaka1
1Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-Ku, Kyoto, 606-8507, Japan.
Abstract:
Though vascular endothelial growth factors (VEGF) and other proangiogenic factors, such as angiopoietins (Ang), may be involved in the development of neovascular age-related macular degeneration (nvAMD), only drugs that inhibit the VEGF family are available for the treatment. The newly approved anti-VEGF drug faricimab, which also inhibits Ang-2, is expected to be effective in patients with AMD refractory to conventional anti-VEGF drugs. Therefore, we prospectively investigated the efficacy of faricimab in the treatment of aflibercept-refractory nvAMD. Patients with nvAMD who had been treated with aflibercept in the last year and required bimonthly injections were recruited. 25 eyes showed persistent exudative changes immediately before the faricimab injection (baseline). In these 25 eyes, switching to faricimab did not change visual acuity or central retinal thickness 2 months after the injection; however, 56% of eyes showed reduction or complete absorption of fluid. Notably, 25% of the eyes that showed dry macula at month 2 had no fluid recurrence for up to 4 months. These results indicate that faricimab could benefit some patients with aflibercept-refractory nvAMD.
Insights
Faricimab, an anti-VEGF and Ang-2 drug, showed potential in treating neovascular age-related macular degeneration (nvAMD) resistant to aflibercept. While not improving vision immediately, it reduced retinal fluid in over half of refractory nvAMD patients.
Area of Science:
- Ophthalmology
- Medical Research
Background:
- Neovascular age-related macular degeneration (nvAMD) is often treated with anti-VEGF drugs.
- Some patients develop resistance to existing anti-VEGF therapies like aflibercept.
- Faricimab is a novel bispecific antibody targeting both VEGF and Angiopoietin-2 (Ang-2).
Purpose of the Study:
- To investigate the efficacy of faricimab in patients with nvAMD refractory to aflibercept treatment.
- To assess changes in visual acuity, retinal thickness, and fluid levels after switching to faricimab.
Main Methods:
- Prospective investigation of patients with nvAMD previously treated with aflibercept.
- Recruitment of patients requiring bimonthly injections and showing persistent exudative changes.
- Evaluation of visual acuity, central retinal thickness, and intraretinal/subretinal fluid at baseline and 2 months post-faricimab injection.
Main Results:
- Switching to faricimab did not significantly alter visual acuity or central retinal thickness at 2 months.
- 56% of eyes demonstrated a reduction or complete absorption of retinal fluid.
- A notable 25% of eyes achieving a dry macula at 2 months maintained this status for up to 4 months.
Conclusions:
- Faricimab may offer a therapeutic benefit for a subset of patients with aflibercept-refractory nvAMD.
- The drug shows potential in managing persistent exudative changes even when initial treatments fail.
- Further research is warranted to understand long-term efficacy and patient selection for faricimab in refractory nvAMD.
