Switching to Faricimab Improves Aflibercept-Resistant Diabetic Macular Edema

Switching to faricimab can improve visual and anatomical outcomes for a clinically significant minority of patients with diabetic macular edema (DME) who have been resistant to treatment with aflibercept, according to research published in Clinical Ophthalmology. This data is first to report 12-month results of faricimab after aflibercept-resistant-DME.

Close to 40% of aflibercept-resistant eyes with DME maintained a fluid-free macula at 12 months after switching to faricimab. They also achieved a mean reduction in central macular thickness (CMT) (from baseline 400.2 [385.3–415.3] to 340.6 [324.3–356.9] µm by the study’s conclusion; P <.01).

A cohort of 51 eyes of 51 participants from a private practice in Texas presented with refractory DME. All participants had undergone 8 or more aflibercept injections in the preceding 12 months before switching to faricimab. Patients were evaluated using optical coherence tomography (OCT), as well as Snellen charts converted to logarithm of the minimum angle of resolution (logMAR).

In 12 months after a switching to faricimab with a treat-and-extend protocol, 39.2% achieved treatment intervals of 8 weeks or longer, along with fluid resolution. Additionally, 21.6% increased visual acuity by 3 Snellen lines or more. In all, visual acuity when starting faricimab was 0.60 (0.54–0.66) logMAR, and improved in 12 months to 0.47 (0.41–0.53) logMAR (P <0.01).

“In the DME patients meeting the study’s primary outcome (approximately 40%), fewer treatments could be administered over 12 months without compromising the functional and/or anatomical outcomes of the patient,” according to the study’s author. He also notes that, after switching to faricimab, “the mean decrease in CMT on OCT was manifested by 4 months and remained stable throughout the study period of 12 months, whereas the mean improvement in visual acuity at 4 months was approximately half the value obtained at 12 months, suggesting visual acuity may gradually improve over 12 months in this study population.”

Previous research indicates long-term visual acuity depends on resolution of residual edema. This suggests that the absence of any clinically meaningful treatment response in the majority of the patients after switching to faricimab may be due to enduring retinal damage and photoreceptor loss prior to the switch.

Limitations of this interventional case series include its retrospective nature, lack of control set, and visual acuity observed with Snellen charts converted to logMAR, instead of ETDRS measurement.

This article originally appeared on Ophthalmology Advisor