Diabetic Macular Edema

Faricimab matches aflibercept in VA improvement, outperforms in reducing retinal thickness for DME

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Treatment with faricimab for diabetic macular edema (DME) with baseline best-corrected visual acuity (BCVA) ≤20/50 is as effective as aflibercept in improving visual acuity, while also providing greater reductions in retinal thickness and requiring fewer injections over 2 years, according to a study.

A recent analysis from the DRCR.net Protocol T suggests that the response to treatment in patients with DME may depend on BCVA. The current study evaluated the efficacy of faricimab 6 mg versus aflibercept 2 mg over 2 years in patients with DME.

In the YOSEMITE and RHINE trials, patients with center-involving macular edema secondary to type 1 or type 2 diabetes were randomized to receive faricimab every 8 weeks (Q8W), faricimab based on a personalized treat-and-extend regimen (T&E), or aflibercept Q8W.

Post hoc subgroup analyses focused on patients with baseline BCVA ≤20/50 (ETDRS letters <69). ETDRS BCVA and central subfield thickness (CST) changes from baseline to years 1 and 2 were compared between the treatment arms.

The results revealed that in both the YOSEMITE and RHINE trials, the mean change in ETDRS BCVA was comparable across all treatment groups at year 1 and year 2. In the YOSEMITE trial, the adjusted mean change in CST at year 1 was significantly greater for the faricimab Q8W (-232.8 μm) and faricimab T&E (-217.4 μm) groups compared to the aflibercept Q8W group (-190.4 μm). Similar patterns were observed in the RHINE trial, with faricimab Q8W and T&E showing greater CST reductions than aflibercept Q8W.

By year 2, patients treated with faricimab Q8W demonstrated greater CST reduction than those treated with aflibercept.

The median time to achieving CST <325 μm and the absence of intraretinal fluid was shorter for patients in the faricimab groups, who also required fewer injections on average.

Zarbin M, Tabano D, Ahmed A, et al. Efficacy of Faricimab vs Aflibercept in Diabetic Macular Edema in the 20/50 or Worse Vision Subgroup in Phase 3 YOSEMITE/RHINE Trials. Ophthalmology. 2024;S0161-6420(24)00320-8. doi: 10.1016/j.ophtha.2024.05.025. Epub ahead of print. PMID: 38852921.