Drs Nathan Steinle, Adrienne Scott, Carl Regillo, and Prethy Rao share their approaches to dosing recommendations for faricimab in the treatment of neovascular AMD.
Nathan Steinle, MD: On label for faricimab, it’s 4 loading doses. In your real-world clinical practice, do you follow the loading dose regimen of 4 injections up front monthly for your patients?
Adrienne Scott, MD: I do, Dr Steinle.
Nathan Steinle, MD: Oh, you do. All right.
Adrienne Scott, MD: I do, and the reason why is I look, and I say, well if I want to come close or approximate these types of outcomes for my patients, I’ll try to adhere the best I can to what evidence base I have. Now, that of course is based upon how I feel, like is a patient most likely to follow up? But I tend to try to adhere to the clinical trial recommendations.
Nathan Steinle, MD: Good to hear.
Adrienne Scott, MD: Well, I try. I feel like there’s some induction period in which I want to try to get the eye acclimated to this new molecule. So, I feel like there is a period of time where I like to consider myself achieving some induction or steady state dose of this before I start trying to extend it.
Nathan Steinle, MD: That’s great. How about this side?
Carl Regillo, MD, FACS, FASRS: Maybe a little disagreement. By the nature of the studies, and the way they were designed, it was somewhat arbitrary choosing 3 vs 4 monthly loads, and a lot of that is based on the shape of the curves, both the vision curves and the OCT [optical coherence tomography] curves. Meaning you get most of the initial benefits in efficacy, visually and anatomically, within the first 3 injections. It doesn’t necessarily mean all patients need 3 monthly loading doses. Plus, we’re not doing 3 and then stopping and watching and waiting.
In fact, even going back to the CATT study, it was 1 dose and monthly follow-up PRN as needed, and patients still did well. So taking the totality of the data and so forth, I will treat until I think the macula is as good as it’s going to be. We do usually achieve that in the majority of our patients, meaning essentially a dry macula, within 3 injections. So, it ends up being that we’re probably doing the same thing in the long run, but I’ll start to extend the dose little by little from the get-go, even if they’re dry at 2 months.
Nathan Steinle, MD: In the studies that are out, they did 4 injections, and then they did a disease assessment, and they put them in the different swim lanes, Q8, Q12, Q16 [every 8, 12, or 16 weeks]. Are you doing that at all, or do you do a slow treat and extend after the 4 loading doses?
Prethy Rao, MD, MPH: I think what’s interesting about the clinical trials is they are quick to extend with a longer treatment interval. In practice, I’m a little hesitant to do that because while we control the disease, I think it’s still active underlying, so my concern is the extension is maybe a bit too far out. I do about the 1 to 2 weeks, as Dr Scott does. Then I think time will tell. Once we have a better understanding of how these drugs work long term, we’ll feel more comfortable doing the longer extension, once we know they’re a bit well controlled.
Transcript edited for clarity