Faricimab: An Emerging Therapy for the Treatment of Neovascular Age-related Macular Degeneration

In posterior segment disorders characterized by the growth of abnormal blood vessels, the vascular endothelial growth factor (VEGF) protein is upregulated, which has led to the current standard-of-care treatments targeting this important pathway. Anti-VEGF agents have drastically improved treatment of neovascular age-related macular degeneration (nAMD) and diabetic retinopathy over the past 15 years. However, not all patients respond adequately to anti-VEGF agents, and the need for frequent and prolonged intravitreal anti-VEGF injections can be demanding on patients, caregivers and healthcare systems. There remain unmet needs for improved efficacy, durability and sustainability in the treatment of these chronic retinal diseases, supporting development of novel therapies to target alternative biological pathways. The angiopoietin-2 (Ang-2) protein has also been shown to be upregulated in retinal vascular diseases. This has led to the development of faricimab, which is a novel bispecific antibody designed to effectively bind both VEGF and Ang-2 as a means of further restricting retinal angiogenesis. Phase II studies of faricimab in nAMD have demonstrated durability, with intervals extending from 12 to 16 weeks between injections, and phase III trials are ongoing. This article reviews the role of VEGF and Ang-2 in the pathogenesis of nAMD, and summarizes the clinical investigation of faricimab.