Extending Treatment Intervals with Durable Therapies for nAMD and DME - Episode 2

Use of Faricimab in Clinical Practice in nAMD and DME

Published on: 

Drs Rishi P. Singh and M. Ali Khan review the real-world experience of using faricimab to treat nAMD and DME, as well as its durability compared to clinical trials.

Rishi P. Singh, MD: We’ve obviously had the newer generation, anti-VEGFs [vascular endothelial growth factor] and Ang2 inhibitors together approved recently. We had recent approval of faricimab, which is a combined bispecific Ang2 anti-VEGF treatment. We had high-dose aflibercept approved as well, which was…8 mg of aflibercept compared to the 2 mg standard dosing. I think that faricimab was first on the scene, and we’ll talk about that a little bit more in detail. I would like to get your clinical insights as far as how it’s played out in your practice. And what I can tell you about the studies in LUCERNE, which are the neovascular AMD [age-related macular edema] trials and the YOSEMITE and RHINE trials, which were the DME [diabetic macular edema] trials, is that they were able to show with a comparator to aflibercept given every 8 weeks that they were able to treat-and-extend these patients with a set force paradigm to a significant extent. And in fact, 75% or 78% of patients were able to achieve a Q12 week [every 12 weeks] or beyond interval of retreatment into year 2. And I’d just like to ask you, given some of this baseline data from YOSEMITE and RHINE and TENAYA and LUCERNE, which we saw similar numbers and rates of 70% to 80 % Q12 and beyond, what are you seeing in clinical practice? Are these patients getting that durability or is it because you’re using one of those for recalcitrant patients more often than not and then treating those patients and may not see the same benefit per se?

M. Ali Khan, MD, FACS, FASRS: Yeah, I think that’s the big distinction. Are we really [working with] treatment-naive patients or are we [treating] patients who have previously been on high burden anti-VEGF of other agents prior? So for the kind of the initial [treatment-naive population], I think we all have a little less experience because of the relatively newer drug, but I have been able to see patients extend out to the 12 week or more interval. And I think partially because in the trials, the extension was 4 weeks at a time, which is quite a bit longer than I think what most of us do in clinical practice with treat-and-extend, usually 1 to 2 weeks at a time. So I’ve been a little bit more liberal about how far I will extend in between visits, usually 2 weeks or so at least. But for the recalcitrant cases, I think it’s still tough. I mean, I think these are just high anti-VEGF burden patients and even though we’re adding an additional blockade of Ang2, many of these patients have stayed at least on a 6- to 8-week interval similar to what they were before. There’s still some anatomic changes that I feel like I’m seeing anecdotally, but the interval is still tough to extend because of their visual acuity for me. So I think the recalcitrant traces are tough for any drug, to be perfectly honest, but for the treatment-naive, I think we are seeing some longer intervals.

Rishi P. Singh, MD: I couldn’t agree more. In my practice, too, I started dosing faricimab and I did get a week or 2 extension, I think in those patients who are most recalcitrant, but in the treatment-naive population, I don’t think I have enough experience to talk about [it] this far. There have been some real-world clinical trials have shown some…benefit at extending intervals earlier in patients for those conditions. But yet we don’t have enough data; I think a [we need] year out yet to see that difference there.

Transcript is AI-generated and edited for clarity and readability.