Faricimab, a novel anti-angiogenic agent, has demonstrated promising results in treatment-naïve patients with neovascular age-related macular degeneration (nAMD), according to a recent study conducted in Swansea, Wales. The retrospective analysis, involving 66 eyes of 62 patients, investigated the outcomes of a treat-and-extend (T&E) faricimab algorithm for managing choroidal neovascular membranes. The findings suggest that faricimab can provide adequate disease control and allow for extended treatment intervals, potentially reducing the burden of frequent injections for patients.
The study, conducted at Singleton Hospital, included patients diagnosed with nAMD who had not previously received anti-VEGF treatment. Patients received three loading doses of faricimab over an eight-week period, followed by a T&E regimen with extensions in four-week increments or contractions in two-week increments based on macular status. Key parameters assessed included best-corrected visual acuity (BCVA), central macular thickness (CMT), and the presence of intraretinal fluid (IRF) and subretinal fluid (SRF).
Visual and Anatomical Improvements
The results showed significant improvements in both visual acuity and retinal anatomy following faricimab treatment. After the first dose, the average BCVA improved by 2.5 letters, and the average CMT decreased by 65.9 μm. After the third loading injection, patients were assigned to either a four-week or eight-week extension group based on disease activity. Statistically significant improvements in BCVA (6 letters) and CMT (-87.4 μm) were maintained in the eight-week extension group. Furthermore, total retinal fluid decreased by 45% and 70.7%, with only 30% and 12.2% residual IRF and 30% and 24.4% residual SRF, respectively.
Extended Treatment Intervals
Notably, the study demonstrated the potential for extended treatment intervals with faricimab. By the fourth injection post-disease control, 42% of patients had dosing intervals of ≥10 weeks, and by the fifth injection, this percentage increased to 55%. Approximately 24% of patients achieved a 16-week dosing interval. "Our initial data suggests that faricimab can provide adequate disease control in treatment-naive nAMD patients and provide treatment extensions of up to 16 weeks," the researchers noted.
Comparison to Clinical Trials and Real-World Data
The outcomes observed in this real-world study are comparable to those reported in the Phase III TENAYA and LUCERNE trials. The changes in BCVA from baseline were similar (5.8 and 6.6 letters in the trials vs. 6 letters in the study). However, the study utilized three loading injections instead of the four used in the trials, which may explain the slightly lower percentage of patients achieving extended dosing intervals. Compared to other real-world studies, this study demonstrated a higher percentage of patients with intervals ≥12 weeks after five injections.
Safety Profile
The safety profile of faricimab in this study was consistent with previous reports. One patient experienced an adverse event of vitritis and increased intraocular pressure, which was managed appropriately. There were no reported cases of retinal vasculitis or retinal occlusive vasculitis.
Implications for Clinical Practice
The findings from this study suggest that faricimab is a viable first-line therapy for nAMD. The ability to achieve disease control with fewer injections and extend treatment intervals offers significant benefits for patients and healthcare systems. The researchers concluded that adhering to three loading doses does not impede a successful outcome and that faricimab facilitates quick drying of nAMD with fewer clinic visits and rapid extensions of treatment intervals.
