Comparison of functional and morphologic changes between brolucizumab and faricimab in neovascular age-related macular degeneration

Abstract

Purpose This study aimed to compare functional and morphologic changes in the loading phase between patients with treatment-naïve macular neovascularization (MNV) due to neovascular age–related macular degeneration (nAMD) treated with either intravitreal brolucizumab (IVBr) or intravitreal faricimab (IVF) injections in a clinical setting. Methods We retrospectively studied 92 consecutive eyes of 90 patients with neovascular nAMD who were scheduled to receive IVBr (42 eyes of 41 patients) or IVF (50 eyes of 49 patients) injections between October 2021 and December 2022. All patients received three consecutive monthly injections of 6.0 mg/0.05 mL brolucizumab or 6.0 mg/0.05 mL faricimab. The best-corrected visual acuity (BCVA), central foveal thickness (CFT), and central choroidal thickness (CCT) at baseline and 1, 2, and 4 months after the initial treatment were measured and compared between the groups. Results Thirty-seven eyes in IVBr group and forty-seven eyes in IVF group who finished treatments in the loading phase were assessed at the follow-up examination. The BCVA, CFT, and CCT changed significantly after loading phase in both groups (P < 0.05 for both comparisons). The IVBr group had more rapid improvement of the BCVA (P = 0.037) at 1 month than the IVF group, but there was no difference at 4 months (P = 0.367). The CFT and CCT decreases tended to be greater in the IVBr group than in the IVF group throughout the follow-up period. Of the five eyes excluded from the IVBr group, one eye (2.4%) each had intraocular inflammation (IOI) and was a non-responder, and two eyes (4.8%) had retinal pigment epithelial tears after treatment. Of the three eyes excluded from the IVF group, two eyes (4.0%) did not respond to the treatment. Conclusions Both IVBr and IVF injections were well-tolerated and improved the VA in treatment-naïve patients with MNV due to nAMD after a loading phase, although IVBr caused a trend toward faster visual improvements in the BCVA. The IVBr group also had greater reductions of the CFT and CCT than the IVF group. However, the potential for adverse events and no response to treatment with each drug are considerations.

Combined Anti-Ang2/Tie and Anti-Vegf Intravitreal Therapy in Age-Related Macular Degeneration – A Systematic Review

“…Moreover, 44.9% (TENAYA) and 45.7% (LUCERNE) of patients were on 16-week dosing intervals [13]. Maruyama Inoue et al [10] evaluated comparatively the outcomes of faricimab (Vabysmo TM , Roche, 6 mg/0.05 mL) and brolucizumab (Beovu ® , Novartis, 6 mg/0.05 mL), after 3 monthly intravitreal injections, on 90 patients and found similar results. No differences were observed either in BCVA mean gain or decrease of CRT.…”

“…Six studies reported data on naïve nAMD treated with IVF [4,10,12,13,16,25], either as single arm [16,25], or as multiple arms studies [4,10,12,13], proving data supporting non-inferiority of IVF to other anti-VEGF, such as aflibercept, ranibizumab and brolucizumab, in terms of functional and anatomic outcomes. Moreover, Heier et al [13], in the phase 3 study TENAYA and LUCERNE, found that the results could be maintained with up to 16 weeks interval between injections, after a loading period of 4 injections monthly, which would be a significant decreased burden on the patients with nAMD.…”

“…In the reviewed studies, the incidence of systemic serious effects, including APTC events (0.9 -1.2%), was low, and they were not considered related to the treatment. The serious ocular side-effects were few, varying from none [10] to 3.1% [25] and comparable to those encountered in classical anti-VEGF therapy The ocular complications included transient raised intraocular pressure (0 -2.4%), ocular inflammation and vitritis (1.5 -3.1%), that could be managed conservatory, without causing a further decreased in vision. Schönbach et al [26] reported a case of postoperative hypotony and suprachoroidal haemorrhage, in a patient with no significant risk factors, which resorbed with medical therapy after 2 months.…”

“…However, they did not find superior BCVA or improvements in other anatomical results with IFV in patients previously treated with intravitreal aflibercept of brolucizumab [15]. Maruyama-Inoue et al [10] found in a real-life study with a 4 months follow-up that the improvements in VA and decrease of CCT and CMT were more significant in IVBr vs. IVF group at 1 month, but the outcomes were not statistically different at 4 months follow-up. One explanation might be the smaller molecule of brolucizumab compared to faricimab (26 vs. 146 kDa), which may diffuse earlier into retinal tissue.…”

“…Several experimental studies showed that this cytokine has an important role both in inflammation and exudation, by competing Angiopoietin 1 in binding Ang/Tie 2 receptors, thus sensitizing blood vessels to the effects of vascular endothelial growth factor-A (VEGF-A) [7][8][9]. Faricimab is a novel 146 kDa monoclonal antibody that specifically and independently binds VEGF-A and Ang2 by its two distinctive Fab regions [10]. By this dual action, faricimab was associated to antiinflammatory and vessel stabilizing effects that may last longer compared to classical anti-VEGF agents.…”