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Targeting the Tie-2 Receptor With Faricimab in Central Serous Chorioretinopathy: A Case Series Motivated by a Genetic
Joel T Rämö1, Leo A Kim2, Tomasz Stryjewski3
1From the Broad Institute of MIT and Harvard (J.T.R., E.J.R.), Cambridge, Massachusetts, USA; Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE) (J.T.R.), University of Helsinki, Helsinki, Finland; Massachusetts Eye and Ear (J.T.R., D.E., L.S., D.G.V., E.J.R.), Boston, Massachusetts, USA.
Purpose:
To investigate the effects of faricimab, a bispecific antibody targeting VEGF and Ang-2 (thus increasing Tie-2 activity), in patients with CSC based on a recent genetic study that implicated Tie-2 signaling in CSC pathophysiology.
Design:
A retrospective interventional multicenter case series.
Methods:
We included patients with chronic CSC (persistent or recurrent SRF for ≥6 months) who received at least one faricimab 6 mg injection between January 1 2022, and April 1 2024,. Study sites included Massachusetts Eye and Ear and University of California San Francisco. Patients with evidence of a choroidal neovascular membrane on color photos, optical coherence tomography (OCT) and/or fluorescein angiography were excluded. 16 eyes (15 patients) met the inclusion criteria. The median central macular thickness at each visit from 52 weeks before to 52 weeks after the first faricimab injection was calculated using automated Heidelberg Spectralis ETDRS subfield measurements.
Results:
Prior to treatment with faricimab, CSC had been diagnosed a median of 4.1 years (range 0.9-8) earlier and SRF (and intraretinal fluid [IRF] in a subset) had been continuously present for a median of 30 weeks (range 9-257). Decreases in macular thickness were observed in 14/16 eyes after the first faricimab injection and in 14/16 eyes in the full follow-up period compared with prior, 10 of which experienced complete resolution of SRF following the start of the first series of injections at a median of 4 weeks (range 2-25). One eye worsened after the second injection. The median improvement in macular thickness was 40 μm [range -3 to 89.5] (P = .0007). Upon review of OCT images, reductions in macular thickness were consistent with reductions in SRF and/or IRF. Visual acuity improved by 2 lines or more in 6/16 eyes.
Conclusions:
In a retrospective case series of patients with chronic CSC and longstanding SRF, we observed improvement in macular thickness after intravitreal faricimab. While the small number of patients and variable natural history of CSC preclude definitive conclusions, a randomized controlled trial seems warranted.
Insights
Faricimab, a novel bispecific antibody, demonstrated significant improvements in macular thickness for patients with chronic central serous chorioretinopathy (CSC). This suggests potential for faricimab in managing this condition, warranting further investigation.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Vascular Biology
Background:
- Chronic central serous chorioretinopathy (CSC) is characterized by persistent subretinal fluid (SRF).
- Recent studies suggest Tie-2 signaling plays a role in CSC pathophysiology.
- Faricimab targets both VEGF and Ang-2, thereby modulating Tie-2 activity.
Purpose of the Study:
- To evaluate the efficacy of faricimab in patients with chronic CSC.
- To assess the impact of faricimab on macular thickness and SRF in CSC.
Main Methods:
- Retrospective, interventional, multicenter case series.
- 16 eyes (15 patients) with chronic CSC received at least one intravitreal faricimab injection.
- Central macular thickness was measured before and after treatment.
Main Results:
- 14/16 eyes showed decreased macular thickness after faricimab treatment.
- 10/16 eyes achieved complete SRF resolution.
- Median improvement in macular thickness was 40 μm (P = .0007).
Conclusions:
- Intravitreal faricimab improved macular thickness in chronic CSC patients with longstanding SRF.
- The findings support further investigation with a randomized controlled trial.
- Faricimab shows promise as a therapeutic option for chronic CSC.
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