Presented at AAO 2023, Kendra Klein-Mascia, MD, discussed her team’s study, comparing faricimab with aflibercept. The study found 2 injections of faricimab gets rid of 75% of retina fluid by week 8, but for aflibercept, erasing the same amount of fluid takes 3 injections until week 12.
A new study compared injections of faricimab versus aflibercept, finding faricimab dries retinas in patients with neovascular age-related macular degeneration (nAMD) more rapidly with fewer doses and fewer serous retinal epithelial detachment.1
Kendra A. Klein-Mascia, MD, from Lahey Hospital and Medical Center at Beth Israel Lahey Health in Burlington, MA, presented the study at the 127th Annual American Academy of Ophthalmology (AAO) Congress in San Francisco, California. She said how the study sought to answer the question: “Does dual Ang-2 VEGF-A inhibition impact anatomical outcomes in neovascular AMD?”
The phase 3 trial followed the TENAYA and LUCERINE trial design. Varun Chaudhary, MD, of the Alcon Laboratories, also spoke about the trial during AAO 2023 in a separate presentation, discussing the promise of extending faricimab treatment to 20 weeks.2 Klein-Mascia’s presentation focused on discussing the greater central subfield thickness reductions with faricimab versus aflibercept—and her team found greater central subfield thickness reductions with faricimab than aflibercept during the head-to-toe dosing phase.1
Patients had either 6 mg up to q16 weeks of faricimab (n = 665) or 2 mg q8 weeks of aflibercept (n = 664). The mean baseline of central subfield thickness was 356.8 up to q16W on faricimab (the mean difference: -1330 (-136.7 to -129.3) µm and 357 by q8W on aflibercept (mean difference: -145.4 (-149.1 to -141.8%) µm.
The investigators found quadrupling the anti-VEGF dose did not improve fluid control until week 12—they looked at 4 times of the dose aflibercept (PULSAR) and 4 times the dose of ranibizuman (HARBOR).
To examine if faricimab or aflibercept was more likely to lead to a dryer retina, the team looked for the absence of subretinal fluid and intraretinal fluid. At baseline, the absence of subretinal and intraretinal fluid was 10% for aflibercept and 12% for faricimab. At 4 weeks, the absence was 49% for aflibercept and 60% for faricimab. At 8 weeks, the absence was 62% for aflibercept and 82% for faricimab, and lastly for. At 12 weeks, it was 67% for aflibercept and 77% for faricimab. Thus, more patients had a dry retina with faricimab than aflibercept.
“In a post-hoc analysis we found that the first absence of intraretinal fluid and subretinal fluid was achieved earlier and, in more patients, treated faricimab compared with aflibercept,” Klein-Mascia said. “The time point at which the commutative incidence of absence of intraretinal fluid and subretinal fluid reached 75% was week 8 in the first faricimab arm in the median of 2 injections.”
Meanwhile, aflibercept did not get rid of intraretinal fluid and subretinal fluid until week 12 and 3 injections.
Klein-Mascia said the team also looked for the presence of serous retinal epithelial detachments, and fewer patients had this with faricimab than aflibercept at week 12. For participants who had serous retinal epithelial detachments, 12.3% were on aflibercept and 3.9% were on faricimab. The difference was -8.4% (95% CI, -1.47 to – 2.00; P = .0258).
The investigators also found that faricimab was well-tolerated and had a comparable safety profile to aflibercept. For instance, for intraocular inflammation events, which include uveitis, iritis, iridocyclitis, viritis, post-procedural inflammation, chorioretinitis, keratic precipitates, non-infectious endophthalmitis, and anterior chamber flare, faricimab up to q17w was 20 while aflibercept was 15. Also, faricimab and aflibercept had 0 retinal vasculitis events, and faricimab had 1 for retinal artery embolism and aflibercept had 0.
In a case study of an 80-year-old female with nAMD and a baseline best-corrected visual acuity of 20/80, 1 faricimab injection resolved subretinal fluid, and there was a significant reduction in retinal epithelial detachment height. The central subfield thickness changed from 240 µm, 266 µm on the day of the switch, and 239 µm by the 5-week mark.
Therefore, faricimab dries retina’s fluid greater and faster with fewer doses. Also, with faricimab, fewer patients have serous retinal epithelial detachment at week 12 than aflibercept.