APAO 2023: Looking at anatomic outcomes in matched comparison: TENAYA and LUCERNE data
Greater anatomic improvements (central subfield thickness reduction, proportion with absence of subretinal fluid and intraretinal fluid) were seen with faricimab versus aflibercept during the matched dosing period (week 4, week 8, and week 12).
Analysis of data from the pooled TENAYA and LUCERNE studies showed the faricimab(Vabysmo, Genentech) achieved greater anatomic improvements compared with aflibercept (Eylea, Regeneron) during the matched-dosing period.
Faricimab improved fluid outcomes versus aflibercept during the matched dosing phase, according to Gemmy Cheung, MBBS, FRCOphth, and colleagues, who presented their results at the 2023 Asia-Pacific Academy of Ophthalmology Congress in Kuala Lumpur, Malaysia.
Cheung, who is from the Singapore Eye Research Institute, Singapore National Eye Centre, Duke-National University of Singapore, Singapore, discussed the implications for clinical practice.
Faricimab is a molecule with dual activity, in that it inhibits both the angiopoietin 2 and vascular endothelial growth factor (VEGF)-A signaling pathways. In the TENAYA and LUCERNE trials, patients received either aflibercept 2.0 mg (664 patients) or faricimab 6.0 mg (665 patients). Patients in the aflibercept arm received monthly dosing between baseline and week 8, followed by fixed 8-weekly dosing until the of the study. Patients in the faricimab arm received monthly dosing between baseline and week 12 and received further retreatment at every 8-week and every 16-week intervals, according to disease activity assessment at weeks 20 and 24. From week 64 onwards, retreatment in the faricimab arm followed a treat-and-extend protocol during which the treatment was extended by 4 weeks or reduced by 4 or 8 weeks or maintained depending on the status of the retina.
Over the 2-year course of the study, Cheung reported, the patients in the faricimab arm achieved disease control with fewer injections, 10, compared with 15 for aflibercept, and had a letter increase of 4.4 compared with 4.3 for aflibercept. During the treat-and-extend phase, the respective numbers of injections were 3 and 6 with concomitant central subfield thickness decreases of 148.4 and 144.0 microns.
Greater anatomic improvements (central subfield thickness reduction, proportion with absence of subretinal fluid and intraretinal fluid) were seen with faricimab versus aflibercept during the matched dosing period (week 4, week 8, and week 12). Faricimab also resulted in a numerically greater proportion of patients achieving absence of subretinal fluid and intraretinal fluid 8 weeks after the last monthly dose, 64% versus 46%.
The time to first absence of intraretinal and subretinal fluid was 4 weeks earlier with faricimab than with aflibercept.
About 80% of patients treated with faricimabachieved every-12-week dosing or longer by the end of year 2.
The primary take-home messages were that faricimab offered greater drying versus aflibercept during the matched dosing phase; faricimab-treated patients achieved first absence of fluid faster and with fewer injections versus aflibercept; durable vision gains and anatomic outcomes with faricimab were achieved at the end of the first year and maintained at year 2, with ~80% of patients with every-12-week or longer dosing; finally, faricimab was well-tolerated.
