Twelve-Month Outcomes of Faricimab for Patients With Sub-optimally Responsive Diabetic Macular Oedema in a UK Tertiary Referral Centre

Purpose Evaluating 12-month visual and anatomical outcomes after switching to faricimab in diabetic macular oedema (DMO) patients with sub-optimal response to aflibercept 2mg. Patients and methods Sixty-two eyes of fifty patients were enrolled in this retrospective study at a UK tertiary referral centre. This consisted of DMO patients with sub-optimal response to aflibercept 2mg who were switched to faricimab. Four loading injections of faricimab were given at monthly intervals, followed by a treat-and-extend regime. The sub-optimal response was defined as CST >325 microns or >20% from best CST despite aflibercept 2mg at less than or equal to 8 weekly intervals(≤q8w) having completed a loading dose of aflibercept 2 mg (6 injections at monthly intervals). Outcome measures were best-recorded visual acuity (BRVA), central subfield thickness (CST), and treatment intervals. Results Baseline BRVA was 67.6 (±11.8) letters and CST was 406.4 (±105.9) µm, and the mean treatment interval was 6.5 (±1.8) weeks. At baseline, 24.2% of eyes were treated every 4 weeks (q4w), 19.4% every 6 weeks (q6w), and 56.5% every 8 weeks (q8w). After the 4 th faricimab loading dose, 54 patients continued on treat-and-extend faricimab. BRVA improved to 70.4 (±12.7) letters (p=0.007) while CST reduced to 372.8 (±132.0)µm (p=0.070). The mean injection interval improved to 7.4 (±2.6), 95%CI[0.1, 2.9]weeks. Subjects were followed up for 57.1 (±19.7) weeks, with a mean of 7.92 (±2.53) faricimab injections. At the latest follow-up, BRVA was stable at 68.7 (±14.6)(p=0.918) letters. CST had reduced further to 343.1 (±117.5) µm(p=0.034). Treatment intervals at the latest follow-up were: 3.2% q4w, 9.7% q6w, 30.6% q8w, 3.2% q10w, 11.3% q12w, 1.6% q14w, 6.5% q16w, with 53.2% on ≥q8w. The mean injection interval had also improved to 9.2 (±3.1) weeks(p=0.122). Conclusion In this study, DMO patients with sub-optimal response to aflibercept 2mg experienced improved anatomical outcomes and extended treatment intervals while maintaining vision by switching to faricimab.