The Brent experience: faricimab in practice

Adding real-world data and insights to years of positive clinical trial results, UK consultant ophthalmologist and medical retina specialist Dr Christiana Dinah was the keynote speaker at a recent closed-door event for Vabysmo (faricimab, Roche).

Medsafe-registered for neovascular (wet) age-related macular degeneration (nAMD), diabetic macular oedema (DMO) and macular oedema secondary to retinal vein occlusion (RVO), Vabysmo was added to the Australian Pharmaceutical Benefits Scheme in January 2023 for nAMD and DMO and March this year for RVO, but is still to be funded by Pharmac in New Zealand. Thus, many Kiwi ophthalmologists and ophthalmic staff are still to use it, said Dr Sophie Hill in her introduction as chair of the Roche-sponsored dinner event in Auckland.

Vabysmo (6) — Elza Cherry Augustine and Deborah Chan

Although not yet funded, Vabysmo is the first and only registered treatment available in New Zealand designed to block two causes of nAMD, offering potentially longer injection intervals. A bispecific antibody, it targets and inhibits two signalling pathways linked to a number of vision-threatening retinal conditions by neutralising angiopoietin-2 (Ang-2) and vascular endothelial growth factor (VEGF)-A, said Roche. “Ang-2 and VEGF-A contribute to vision loss by destabilising blood vessels, causing new leaky blood vessels to form and increasing inflammation. By blocking pathways involving Ang-2 and VEGF-A, Vabysmo is designed to stabilise blood vessels.”

Vabysmo (5) — Rosa Jung, Charmaine Alatan and Dr Joel Yap

Dr Dinah completed her medical-retina training at Moorfields Eye Hospital in the UK, is a senior clinical lecturer at Imperial College, London, and has been the principal investigator for more than 25 multicentre clinical trials for retinal diseases. With nAMD now the main cause of sight-loss in the UK and, given the increasing number of patients requiring injections to stave off AMD, DMO, RVO and other retinal diseases, compounded by the huge backlog caused by Covid, there is a huge unmet need in medical retina across the country, she said. This is particularly true in Brent, the north-west London borough where she’s based, a deprived and ethnically diverse area with the highest diabetes prevalence in England. This was one of the key reasons why she was so keen for her clinic to be involved in faricimab’s trials, she said, as any treatment that’s more effective for patients from the get-go and involves fewer treatments per year is welcome.

In January 2022, six months before faricimab was officially approved for UK public patients, Dr Dinah’s Brent clinic was receiving four new nAMD referrals a week and 800–1,000 new referrals annually from the UK’s incredibly successful diabetic eye screening service. Providing approximately 6,000 injections a year, with 25% of patients on four- to five-weekly injection intervals and only 20% on 12-weekly or more intervals, the clinic needed to run two extra Saturday injection lists every month to prevent the backlog building, she said.

Vabysmo (3) — Beatrice Harrap, Dena D’Souza and David Garland

In her presentation, Dr Dinah discussed the research on how faricimab works and its effectiveness in different retinal pathologies and, most importantly she said, the treatment’s durability. Comparing this with her own experience in Brent, she said about 80% of her patients had moved to more than 12-weekly injection intervals by the end of their second year of treatment, which was far higher than other comparable anti-VEGF treatments. Through a series of individual case examples, she then demonstrated how switching some patients to faricimab resulted in better outcomes. “Our experience is with switchers you gain something, but you really see the ‘wow’ factor in the treatment-naïve,” she said.

More than six million doses of Vabysmo have been distributed globally since it was approved in the US in 2022. Between June 2022 and July 2024, nearly 7,000 nAMD eyes were treated with faricimab in the UK, with adverse effects deemed minor or rare. Dr Dinah’s clinic had only one case of endophthalmitis, requiring vitrectomy to restore the patient’s vision to its pre-infective level, she said, which was slightly less than the officially reported infection rates of 0.03% and 0.04% for treatment- naïve and previously treated eyes, respectively.

Vabysmo (4) — Zhen Wu, Richard Johnson and Jen Baker

Returning to Brent, in January 2025, Dr Dinah said her clinic was now receiving 4.5 new nAMD referrals a week, in addition to the new referrals from diabetic eye screening. But they now only needed to staff one extra Saturday injection list each month as less than 10% of patients were on four- to five-weekly injection intervals. She said faricimab is her clinic’s first-line agent for nAMD, DMO and RVO and its preferred treatment for idiopathic polypoidal choroidal vasculopathy and DMO with exudates. She did urge caution, however, for patients with high pigment epithelial detachment levels. But gaining that one extra Saturday a month – “priceless!”