Rapid, sustained vision gains seen with treat-and-extend faricimab for DME

Faricimab (Vabysmo, Genetech) is the first FDA-approved treatment designed to block two proteins involved in the proliferation of abnormal new blood vessels, vascular endothelial growth factor (VEGF) and angiotensin-2 (ang-2). YOSEMITE and RHINE were the pivotal trials for faricimab that led to the drug’s approval for diabetic macular edema (DME). These trials had three arms: in one arm, patients received the anti-VEGF medication aflibercept every two months, a second arm received faricimab every two months, and the third arm used a treat-and-extend protocol for faricimab, a dosing strategy that can enable patients to go longer between office visits. 

At the 2023 Retina Society meeting, Yoshihiro Yonekawa, MD, and colleagues gave a presentation that provided a new analysis of the treat-an-extend arm of these trials. It was already known that some patients in this arm could go for 12-16 weeks between doses of faricimab. This new analysis evaluated how well these patients did in terms of vision and anatomy as the treatment interval was extended. 

The researchers found that there was a rapid visual gain and rapid resolution of the macular edema with faricimab. When dosing intervals were extended, these improvements were sustained in the majority of patients.  “Despite extending the patients to every four month dosing, most of the patients continue to do very well, both in terms of vision and anatomy,” Yonekawa said. He also noted that at the end of the YOSEMITE and RHINE trials, about 56% of patients met the criteria to extend to 20 weeks, although this interval was not evaluated in the study. He suggested that we may learn more about whether the five month interval is effective in future real world studies.

Source: Healio Video Perspective by Yoshihiro Yonekawa, MD, Healio Ocular Surgery News, October 16, 2023; see source video