Faricimab on the PBS

Faricimab has been added to the Pharmaceutical Benefits Scheme (PBS) for the treatment of neovascular (wet) age-related macular degeneration (nAMD) and diabetic macular oedema (DMO).

Faricimab is a monoclonal antibody that inhibits both vascular endothelial growth factor A (VEGF-A) and angiopoietin-2 (Ang2). Inhibition of VEGF-A reduces endothelial cell proliferation, neovascularisation and vascular permeability, while inhibition of Ang2 is thought to increase vascular stability and reduce the effects of VEGF-A on blood vessels. This dual mechanism of action may offer a benefit over medications targeting the VEGF pathway alone, such as aflibercept and ranibizumab.

Another potential benefit of faricimab is the possibility of extending the dosing interval. The manufacturer recommends dosing be initiated at four-weekly intervals for the first four doses. This can then be individualised, with the dosing interval increased up to 16 weeks.

The efficacy of extended dosing intervals was investigated in the TENAYA and LUCERNE trials. Patients with nAMD were randomly assigned to intravitreal faricimab up to every 16 weeks or aflibercept every eight weeks. By week 48, around 45% of faricimab-treated patients were on extended fixed treatment intervals of every 16 weeks, and approximately 80% were on intervals of every 12 weeks or more. The primary endpoint was mean change in best corrected visual acuity (BCVA) from baseline. Faricimab dosing up to every 16 weeks demonstrated non-inferior outcomes compared to aflibercept dosed every eight weeks. Rates of ocular adverse effects were similar for the two treatment groups.