Use of Faricimab (VABYSMO) for highly treatment resistant CNV in Wet-Age Related Macular Degeneration.

Abstract

Purpose : The efficacy of Faricimab for treatment naïve Wet-Age-related macular degeneration has been established, but has not been systematically studied in choroidal neovascularization (CNV) resistant to mainstay and escalated intravitreal treatments. In a consecutive case series, we retrospectively analyzed the therapeutic response to faricimab in eyes that were previously diagnosed with persistent macular edema anatomically unresponsive to aggressive high-dose high-frequency monotherapy (i.e.:monthly 4-mg aflibercept) and/or simultaneous use of anti-VEGF and long-acting steroids. We hypothesized that such treatment-resistant CNV must respond to Faricimab due to its dual mechanism of action (anti-VEGF and anti-ANG-2).

Methods : A total of 22 consecutive eyes (88 injections) with unresponsive CNV, despite treatment escalation consisting of varied doses of alternating anti-VEGF agents (prior mean:35.52±SD17.12[8-86]). Persistent retinal fluid following an increase in treatment protocol (high-dose high-frequency anti-VEGF and/or combination anti-VEGF with steroid) was considered resistance. Treatment consisted of the standard of care intravitreal administration of Faricimab. Slit-lamp evaluation, Visual Acuity, Intraocular pressure, and Optical Coherence Tomography measurements of central retinal thickness (CRT) were recorded every 4 weeks pre-/post-injection for 4 consecutive months. Outcomes included changes in CRT, VA, and IOP.

Results : We performed our initial analysis post-first injection of Faricimab. Safety data showed no issues. Anatomic outcomes showed a statistically significant reduction in CRT compared to baseline; paired analysis showed an average CRT reduction of 56.65 μm(p<0.0004) at 1-month, 53.79 μm(p=0.0008) at 2-month, 53.69 μm(p=0.01) and 3-months. There was a non-significant improvement in BCVA and IOP; no eyes required glaucoma surgery or showed vascular occlusions.

Conclusions : We found that an initial injection with Faricimab produced clear anatomic improvement in highly treatment resistant CNV. Other studies evaluating Faricimab found visual and anatomic improvement, but solely in treatment naïve eyes and not those resistant to monotherapy and combination. In such eyes we found overall disease improvement, particularly anatomic. Faricimab may help treat resistant Wet-AMD when all other therapeutic options have been exhausted. Earlier use may benefit these eyes as well.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.