Systematic Review and Network Meta-Analysis of Durability of Faricimab in Neovascular Age-Related Macular Degeneration

OBJECTIVES:

Faricimab is a bispecific antibody targeting ANG-2 and VEGF for the treatment of neovascular age-related macular degeneration (nAMD). In the TENAYA and LUCERNE trials, patients treated with individualized dosing of faricimab followed by a Treat & Extend (T&E) regime required less frequent treatments compared to aflibercept given every eight weeks (Q8W) without compromising efficacy. About 80% of patients treated with faricimab could extend their intervals beyond Q8W. However, clinical practice in nAMD is typically characterized by T&E as well as pro re nata (PRN) regimens. This research aims to assess the durability profile of faricimab vs. anti-VEGF treatments applied in such regimens.

METHODS:

A systematic literature review was conducted to identify randomized clinical trials of anti-VEGF treatments in nAMD. The main outcome was the mean number of injections after two years. 14 studies with relevant data were eligible informing a Bayesian Network Meta-Analysis to estimate the durability of faricimab vs. other anti-VEGF treatments. Differences and the probability of faricimab being better were calculated using random-effects (RE) and fixed-effect (FE) models.

RESULTS:

At the two year time point, the mean differences in number of injections favored faricimab vs. T&E and PRN regimens using a RE model. The point estimate vs. bevacizumab, ranibizumab, aflibercept and brolucizumab applied in a T&E regimen was -6.71, -4.43, -1.76 and -1.89 respectively. The associated probability of faricimab requiring less frequent dosing than comparators was 96%, 95%, 80% and 84%. For PRN regimens, a comparison was possible vs. ranibizumab with a mean difference of -3.72 and an associated probability of faricimab requiring less frequent dosing of 90%. FE results were consistent.

CONCLUSIONS:

The results indicate that there is a high probability that faricimab is associated with a better durability profile than current treatment options administered in flexible regimes that are typically used in clinical practice.