Faricimab for Treatment-Resistant Diabetic Macular Edema

Abstract

To assess the short-term outcomes in treatment-resistant diabetic macular edema (DME) patients changed from intravitreal aflibercept (IVA) to intravitreal faricimab (IVF). Methods: A retrospective review was undertaken on DME subjects receiving IVA therapy at a single private practice. Patients were separated into study and control cohorts. Both study and control patients had received more than or equal to six IVA injections during the preceding 12 months, more than or equal to four IVA injections during the preceding 6 months, had a central macular thickness (CMT) on optical coherence tomography (OCT) of ≥300 µm, and had retinal fluid on OCT before cohort assignment. Study patients were switched to IVF and underwent three injections within 4 months, whereas control patients stayed on IVA during the same period and received three injections within 4 months. Results: There were 51 patients analyzed. There were 37.5% (9/24) in the study group and 3.7% (1/27) in the control group who achieved a CMT of less than 300 µm without retinal fluid on OCT at the end of the 4-month study (p=0.001). There were 41.7% (10/24) in the study group and 11.1% (3/27) in the control group who had gained two or more lines of visual acuity at the end of the 4-month study (p=0.01). Conclusion: For a significant minority, IVF can improve the short-term visual and anatomic outcomes in treatment-resistant DME patients formerly managed with IVA. Longer follow-up is needed to determine if such improvements can be preserved.

REal-world treatment outcomes after delayed intRavitreal therapy in center-involving diabetic macular edema – RETORT study

“…A recent study by Elnahry et al found that OCT and OCT-angiography markers, such as a higher CSFT and a smaller foveal avascular zone area, as well as increased vessel densities in superficial parafovea and deep fovea, were associated with a better response to monthly intravitreal bevacizumab injections than in non-responders [ 24 ]. Patients who do not respond adequately to standard anti-VEGF medications may benefit from treatment with new and potent anti-VEGF molecules such as brolucizumab and faricimab [ 25 , 26 ]. Long-term, chronic, untreated DME appears to develop resistance and a poor treatment response to routine antiangiogenetic drugs in general, according to studies [ 27 , 28 ].…”

“…Long-term, chronic, untreated DME appears to develop resistance and a poor treatment response to routine antiangiogenetic drugs in general, according to studies [ 27 , 28 ]. These eyes can also be treated with potent anti-VEGF molecules like faricimab [ 26 ]. Corticosteroid therapy, which controls the crucial role of inflammation in DME, is used to treat persistent, chronic DME [ 29 ].…”

Topical Dorzolamide as Adjunctive Treatment with Intravitreal Bevacizumab in Bilateral Diabetic Macular Edema (DME)

“…Intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents has been regarded as the gold standard treatment as the rst option for center-involving DME (CI-DME) (2). However, in some cases of DME, the treatment with anti-VEGF agents tends to be unsatisfactory (3). Thus, research for more satisfactory treatment options pursues.…”

Faricimab for treatment of diabetic macular oedema

“…Additionally, by exclusively targeting VEGF, there is an unmet need for anti-VEGF sub-responsive patients. 16 Some can be treated with cortico-steroid implants; however, these have a higher side effects profile such as development of cataract and glaucoma. In this direction, the role of the Ang/Tie pathway has been investigated with promising results for the treatment of DME.…”

“…The burden of such frequent injection intervals and associated cost have driven efforts to study other alternative molecular pathways as possible new treatment targets. Additionally, by exclusively targeting VEGF, there is an unmet need for anti‐VEGF sub‐responsive patients 16 . Some can be treated with cortico‐steroid implants; however, these have a higher side effects profile such as development of cataract and glaucoma.…”