Brolucizumab and faricimab as new treatment options for diabetic macular edema: perspective
Keywords:Brolucizumab, Diabetic retinopathy, Faricimab, Macular edema
Diabetic macular edema (DME) is the leading cause of blindness in the working populations, with patients requiring 10.7 intravitreal injections of anti- vascular endothelial growth factor (VEGF) agents per year. The high rate of non-compliance of anti-VEGF injection in patients with DME and the unmet need in current regimen may result in suboptimal visual outcome. Brolucizumab, an antibody fragment anti-VEGF-A agent, has been approved to treat neovascular age-related macular degeneration, as illustrated in the HAWK and HARRIER trials. Similarly, the KESTREL and KITE DME trials have shown that brolucizumab 6 mg achieves greater improvement in best-corrected visual acuity and greater reduction in central subfield thickness at week 52, compared with aflibercept 2 mg. Fewer patients with brolucizumab have intraretinal and subretinal fluid. Careful monitoring, prompt diagnosis, and timely intervention enable early management of adverse effects including intraocular inflammation and retinal artery occlusion. Moreover, in the BOULEVARD trial, patients with DME on faricimab 1.5 and 6.0 mg have demonstrated greater gain in Early Treatment Diabetic Retinopathy Study letters and greater reduction in central subfield thickness, compared with patients on ranibizumab 0.3 mg. The YOSEMITE and RHINE trials have demonstrated greater improvement in best-corrected visual acuity and two-step Diabetic Retinopathy Severity Scale at week 52 after faricimab 6 mg than after aflibercept 2 mg. Thus, brolucizumab and faricimab are efficacious, durable, and well tolerated, with improved treatment outcome and patient compliance.
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