Retina Society 2023: Personalized faricimab dosing shows promise in extending wet AMD treatment intervals

Michael Engelbert, MD, PhD, shared insights from his 2023 Retina Society presentation, titled "Personalized Faricimab Dosing Increased the Proportion of Patients With nAMD Achieving Q16W Dosing in Year 2 of TENAYA/LUCERNE, While Maintaining Functional and Anatomical Outcome," with Sheryl Stevenson, Group Editorial Director - Eye Care.

Video Transcript

Editor's note - This transcript has been edited for clarity.

Sheryl Stevenson: We are joined today by Dr. Michael Engelbert, who will be presenting at this year's Retina Society meeting. Welcome to you. We're delighted to have you, and curious to learn more about your presentation regarding personalized faricimab dosing in a recent study. Can you tell us about that?

Michael Engelbert, MD, PhD:What we were interested in studying is where the patients in TENAYA and LUCERNE, who had been treated with a variable-dosing interval during Year 1 with faricimab after four initial injections and then compared to aflibercept given at Q8W fixed intervals, where those patients would end up in Year 2.

My personal concern was that many of the patients that reached 4 months — which is something that we don't see all that commonly with the other drugs that we've been using — my concern was that many of those patients would have to move back to shorter intervals. It was nice to see that in the second year of the study, for most patients, whether they were on Q8, Q12, or Q16 at the end of Year 1, the vast majority, the decision was made to either maintain or to extend those intervals. That was for about 90% of patients.

What was very interesting is that of the patients that were on the Q16W interval, the vast majority (70%) remained on that interval. Many of the patients who were on Q12W (60%) moved on to Q16 in the second year, and even of the ones that were on Q8W (60%) moved on to longer intervals...so Q12 or Q16. That was very encouraging to see in Year 2.

Another thing that was a concern is that with these very long intervals, there would be potentially a recurrence of a macular hemorrhage, a potentially very sight-threatening event. Luckily, that was only seen in less than 1% of patients that that was the reason for having to tighten the interval.

Stevenson: Were there any other interesting or surprising discoveries or outcomes along the way that came up?

Engelbert: The study really aimed to create criteria that mirror what we do in clinical practice. What was nice to see that just as in clinical practice where we look mostly at the OCT [optical coherence tomography] when we make the decision to maintain or extend someone, in most of the cases where a decision was made to reduce the interval, it was driven by criteria on the OCT and not by a decrease in vision or macular hemorrhage. I found that reassuring.

Stevenson: What would you consider the next step to be or further research?

Engelbert: I'm looking forward to seeing what AVONELLE is going to show — the long-term, open-label extension arm of this and see how these patients with these very long intervals will do. In the long term, we know from past studies that patients that don't get frequent injections end up doing not so well. Undertreatment has really been the main problem for the vast majority of patients that experience a decline in their vision over time, aside from the development of geographic atrophy, of course.

Here, we have a drug where we can be hopeful that it's going to increase compliance and improve outcomes for patients, not just over the course of a year or two, but also long term. I'm excited to see the data for that eventually.