‘Don’t give up’: Persistent treatment with faricimab shows promise for delayed responders
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Patients with neovascular age-related macular degeneration who have responded poorly to anti-VEGF monotherapy may require an average of nine injections of faricimab before improvement is seen.
“Our message is, ‘Don’t give up, and manage these patients’ expectations accordingly,’” Judy Chen, MD, of West Coast Retina Medical Group, said at the American Society of Retina Specialists annual meeting.
Phase 3 clinical trials of Vabysmo (faricimab, Genentech), which was FDA approved for the treatment of wet AMD in January 2022, enrolled only treatment-naive patients.
“However, most retina specialists today are using faricimab as second- or third-line treatments, meaning that patients are being switched from an already established anti-VEGF regimen,” Chen said.
Since then, several studies have evaluated switching to faricimab as a second- or third-line treatment, but these studies have typically been short term, evaluating patients who received less than six to eight injections, Chen said. In addition, they have failed to discuss clinical characteristics that could lead to improved success rates with faricimab.
In response, Chen and colleagues designed a retrospective chart review of patients considered incomplete or nonresponding to anti-VEGF monotherapy who had neovascular AMD and were switched to faricimab between February 2022 and January 2024.
Only patients who had achieved complete response to faricimab during the study period were included in the final study to investigate the clinical characteristics that could lead to that response.
Thirty-three eyes of 32 patients were evaluated. They had received a minimum of three anti-VEGF injections and had a diagnosis of neovascular AMD for at least 1.5 years before switching to faricimab.
“These patients were found to spontaneously separate into two groups,” Chen said.
The first group, consisting of 16 eyes, exhibited quick response, achieving full clearance of fluid with fewer than five injections of faricimab.
The second group, consisting of 17 eyes, was defined as delayed responders and required more than five injections before full clearance of fluid.
No differences were seen between the two groups regarding gender, race, age at AMD diagnosis, years since diagnosis, previous anti-VEGF therapy or prior number of injections.
Quick responders had a longer treatment interval before switching to faricimab, better baseline best corrected visual acuity and smaller baseline pigment epithelial detachment size.
“Patients who are more likely to be delayed responders will have shorter treatment intervals, worse baseline best corrected visual acuity and larger pigment epithelial detachments,” Chen said.
She noted that BCVA can catch up in delayed responders with persistent treatment.
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Chen J. Don’t give up! Clinical characteristics leading to a delayed response to faricimab therapy in difficult-to-treat nvAMD patients. Presented at: American Society of Retina Specialists annual meeting; July 17-20, 2024; Stockholm.
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