Abstract
Purpose :
To evaluate risk factors and assess real-world outcomes of the use of faricimab in diabetic macular edema (DME) in a veteran population.
Methods :
A retrospective case series chart review was conducted on South Texas Veteran Affairs patients who received faricimab intravitreal injections for primarily previous treatment-resistant DME from September 2022 to July 2023 with at least 1 month of follow-up and no other visually significant ocular conditions. The cases were divided into 2 groups, Success versus Failure as determined by expert clinician opinion to reflect real-world clinical practice.
Results :
29 patients, 44 eyes met inclusion and exclusion criteria with an average of 4.43 prior anti-VEGF injections within the past year. 72.72% (32/44) of eyes were determined to have success with treatment while 27.27% (12/44) of eyes were determined to have failed treatment (lack of response, adverse events, or loss of follow-up). Of the Success group, 93.75% (30/32) of eyes were able to be maintained on a schedule of every 8 weeks or longer. After 1 injection compared to baseline, for the Success group, vision improved by 3.02±1.01 ETDRS letters (p=0.005) and central subfield thickness (CST) improved by 57.44±17.97µm (p=0.003). Comparing risk factors between success and failure groups, age (p=0.766), A1c (p=0.597), diastolic blood pressure (p=0.195), estimated glomerular filtration rate (p=0.596), urine protein/creatinine ratio (p=0.353), lens status (p=0.658), stage of diabetic retinopathy (p=0.087), number of prior injections (p=0.735), time since last anti-VEGF (p=0.981), and previous intraocular steroid use (p=0.053) were not statistically significant. Race was significantly different (p=0.014) between the Success and Failure groups with more White, Hispanic and less White, Non-hispanic patients in the Failure group than expected. 3 patients had adverse events (cataract, anterior uveitis, and death). The anterior uveitis was readily treated with topical steroids with resolution. The case resulting in death was attributed to existing co-morbidities present prior to treatment.
Conclusions :
In real-world clinical practice for a veteran population, the use of intravitreal faricimab for the treatment of previous treatment-resistant DME was overall efficacious and safe with the majority of patients able to be sustained on extended treatment schedules. Race may play a role in treatment outcomes.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.