Faricimab to treat neovascular age-related macular degeneration: perspective
Keywords:Antibodies, bispecific, Faricimab, Intravitreal injections, Visual acuity, Wet macular degeneration
Neovascular age-related macular degeneration (nAMD) is a major cause of vision loss in older adults. Neovascularization is caused by angiogenic mechanisms of the angiopoietin and vascular endothelial growth factor (VEGF) pathways. Standard treatments for nAMD target the VEGF pathway, but the efficacy of single-target anti-VEGF agents is limited by angiopoietin. Some patients may respond inadequately. Faricimab is a bispecific antibody targeting VEGF-A and angiopoietin-2. Its efficacy and safety have been illustrated in the TENAYA, LUCERNE, and TRUCKEE studies. Compared with aflibercept 2 mg, faricimab 6 mg demonstrated rapid best-corrected visual acuity gains and central subfield thickness reductions. A larger proportion of patients did not develop subretinal fluid during the loading phase. Faricimab is well tolerated with a risk-benefit profile comparable to the standard anti-VEGF treatment. Guidelines from the National Institute for Health and Care Excellence and the European Society of Retina Specialists recommend early diagnostic imaging and examinations for timely treatment of nAMD. Faricimab is an efficacious, well-tolerated, and long-acting treatment option for nAMD, with the potential for long-term cost savings.
National Institutes of Health, National Eye Institute. Age-related macular degeneration (AMD). Accessed January 30, 2023. Available from: https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/age-related-macular-degeneration.
Flores R, Carneiro Â, Vieira M, Tenreiro S, Seabra MC. Age-related macular degeneration: pathophysiology, management, and future perspectives. Ophthalmologica 2021;244:495-511.
Buckle M, Lee A, Mohamed Q, et al. Prevalence and incidence of blindness and other degrees of sight impairment in patients treated for neovascular age-related macular degeneration in a well-defined region of the United Kingdom. Eye (Lond) 2015;29:403-8.
National Institute for Health and Care Excellence (NICE). Age-related macular degeneration (NICE guideline). Accessed January 30, 2023. Available from: https://www.nice.org.uk/guidance/ng82.
The Chinese University of Hong Kong. Press release: CUHK Pao So Kok Macular Disease Treatment and Research Centre Opens Study sees correlation between protein angiopoietin2 and wet age-related macular degeneration. Accessed January 30, 2023. Available from: https://www.med.cuhk.edu.hk/press-releases/cuhk-pao-so-kok-macular-disease-treatment-and-research-centre-opens-study-sees-correlation-between-protein-angiopoietin2-and-wet-age-related-macular-degeneration.
Liberski S, Wichrowska M, Kocięcki J. Aflibercept versus faricimab in the treatment of neovascular age-related macular degeneration and diabetic macular edema: a review. Int J Mol Sci 2022;23:9424.
Joussen AM, Ricci F, Paris LP, Korn C, Quezada-Ruiz C, Zarbin M. Angiopoietin/Tie2 signaling and its role in retinal and choroidal vascular diseases: a review of preclinical data. Eye (Lond) 2021;35:1305-16.
Pikkel J, Attas S. "What should I inject next?" Challenging treatment decisions in the multiple anti-VEGF: a review of publications exploring anti-VEGF switching for nAMD. Int Ophthalmol 2018;38:2031-9.
Ng DS, Yip YW, Bakthavatsalam M, et al. Elevated angiopoietin 2 in aqueous of patients with neovascular age related macular degeneration correlates with disease severity at presentation. Sci Rep 2017;7:45081.
Wallsh JO, Gallemore RP. Anti-VEGF-resistant retinal diseases: a review of the latest treatment options. Cells 2021;10:1049.
National Institute for Health and Care Excellence. Faricimab for treating wet age-related macular degeneration (Technology appraisal guideline). Accessed January 30, 2023. Available from: https://www.nice.org.uk/guidance/ta800.
Bhutto I, Lutty G. Understanding age-related macular degeneration (AMD): relationships between the photoreceptor/retinal pigment epithelium/Bruch's membrane/choriocapillaris complex. Mol Aspects Med 2012;33:295-317.
Angiogenesis Foundation. FDA approves faricimab for treatment of wet AMD and DME. Accessed January 30, 2023. Available from: https://angio.org/fda-approves-faricimab-for-treatment-of-wet-amd-and-dme/.
Regula JT, Lundh von Leithner P, Foxton R, et al. Targeting key angiogenic pathways with a bispecific CrossMAb optimized for neovascular eye diseases. EMBO Mol Med 2016;8:1265-88.
American Journal of Managed Care. FDA approves faricimab for treatment of wet AMD and DME. Accessed January 30, 2023. Available from: https://www.ajmc.com/view/fda-approves-fariximab-to-treat-wet-amd-and-dme.
Genentech. VABYSMOTM Prescribing Information. Accessed January 30, 2023. Available from: https://www.gene.com/download/pdf/vabysmo_prescribing.pdf.
European Medicines Agency. Vabysmo (Faricimab). Accessed January 30, 2023. Available from: https://www.ema.europa.eu/en/medicines/human/summaries-opinion/vabysmo.
Chakravarthy U, Bailey C, Brown D, et al. Phase I trial of anti-vascular endothelial growth factor/anti-angiopoietin 2 bispecific antibody RG7716 for neovascular age-related macular degeneration. Ophthalmol Retina 2017;1:474-85.
Sahni J, Dugel PU, Patel SS, et al. Safety and efficacy of different doses and regimens of faricimab vs ranibizumab in neovascular age-related macular degeneration: the AVENUE phase 2 randomized clinical trial. JAMA Ophthalmol 2020;138:955-63.
Cheung G, Guymer, RH, Demetriades AM, et al. Faricimab in neovascular age-related macular degeneration (nAMD): efficacy, safety, and durability through week 48 in the phase 3 TENAYA and LUCERNE trials. In: 2022 EURETINA Congress, 1-4 September 2022; Hamburg.
Lai TYY, Michels S, Demetriades AM, et al. Faricimab in neovascular age-related macular degeneration: 48-week results by dosing interval cohort in the phase 3 TENAYA/LUCERNE Trials. In: 2022 EURETINA Congress, 1-4 September 2022; Hamburg.
Khanani AM, Demetriades AM, Kotecha A, et al. Faricimab in neovascular age-related macular degeneration: year 2 efficacy, safety, and durability results from the phase 3 TENAYA and LUCERNE trials. In: 2022 American Society of Retina Specialists Annual Meeting, 13-16 July 2022; New York.
Heier JS, Khanani AM, Quezada Ruiz C, et al. Efficacy, durability, and safety of intravitreal faricimab up to every 16 weeks for neovascular age-related macular degeneration (TENAYA and LUCERNE): two randomised, double-masked, phase 3, non-inferiority trials. Lancet 2022;399:729-40.
Wong IYH, Ng DSC, Fung NSK, et al. Treat-and-extend regimen for management of neovascular age-related macular degeneration: recommendations from the Hong Kong Retina Expert Panel. Hong Kong J Ophthalmol 2019;23:15-9.
Sheth VS, Khan H, Aziz AA, et al. TRUCKEE study: real-world safety and efficacy of faricimab for neovascular AMD. In: 2022 EURETINA Congress, 1-4 September 2022; Hamburg.
Schmidt-Erfurth U, Chong V, Loewenstein A, et al. Guidelines for the management of neovascular age-related macular degeneration by the European Society of Retina Specialists (EURETINA). Br J Ophthalmol 2014;98:1144-67.
Schwartz R, Loewenstein A. Early detection of age related macular degeneration: current status. Int J Retina Vitreous 2015;1:20.
Optometry Australia. 2019 Clinical Practice Guide for the diagnosis, treatment and management of age-related macular degeneration. Accessed January 30, 2023. Available from: https://www.optometry.org.au/wp-content/uploads/Professional_support/Practice_notes/AMD-Clinical-Practice-Guide-2019_final_designed_v5.pdf.
Yeung L, Hsieh YT, Yang CH, et al. Management of neovascular age-related macular degeneration: Taiwan expert consensus. J Formos Med Assoc 2021;120:2061-71.
Keenan TDL, Cukras CA, Chew EY. Age-related macular degeneration: epidemiology and clinical aspects. Adv Exp Med Biol 2021;1256:1-31.
Pharmaceutical Benefits Advisory Committee Meeting (PBAC): PBAC intracycle meeting outcomes. Accessed January 30, 2023. Available from: https://www.pbs.gov.au/industry/listing/elements/pbac-meetings/pbac-outcomes/2022-05/May-2022-PBAC-Web-Outcomes.pdf.
Compendium of pharmaceutical products 2022. Pharmacy and Poisons Board of Hong Kong. Accessed January 30, 2023. Available from: https://www.ppbhk.org.hk/eng/doc/Compdium.pdf.
How to Cite
Copyright (c) 2023 Hong Kong Journal of Ophthalmology
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The Journal has a fully Open Access policy and publishes all articles under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) licence. For any use other than that permitted by this license, written permission must be obtained from the Journal.