faricimab

General

Pronunciation:
far-ik-i-mab

Trade Name(s)

  • Vabysmo

Ther. Class.

ocular agents

Pharm. Class.

vascular endothelial growth factor antagonists

monoclonal antibodies

angiopoietin-2 inhibitors

Indications

  • Neovascular (wet) age-related macular degeneration.
  • Diabetic macular edema.
  • Macular edema following retinal vein occlusion.

Action

Inhibits vascular endothelial growth factor-A (VEGF-A), preventing the binding of endogenous VEGF-A, resulting in decreased endothelial proliferation, vascular leakage, and new vessel formation. Also inhibits angiopoietin-2, which promote vascular stability and protects blood vessels from the effects of VEGF-A.

Therapeutic Effect(s):

Decreased progression of visual loss.

Pharmacokinetics

Absorption: Intravitreal injection results in complete local bioavailability. Very low serum levels are achieved.

Distribution: Unknown.

Metabolism and Excretion: Catabolized in lysosomes to small peptides and amino acids that are excreted renally.

Half-life: 7.5 days.

TIME/ACTION PROFILE

ROUTEONSETPEAKDURATION
Intravitrealunknownunknownunknown

Contraindication/Precautions

Contraindicated in:

  • Hypersensitivity;
  • Ocular/periocular infections;
  • Active intraocular inflammation.

Use Cautiously in:

  • OB:   Safety not established in pregnancy;
  • Lactation:  Safety not established in lactation;
  • Rep:   Women of reproductive potential;
  • Pedi:   Safety and effectiveness not established in children.

Adverse Reactions/Side Effects

CV: MI, STROKE

EENT: cataract, ↑ intraocular pressure, ↑ lacrimation, conjunctival hemorrhage, endophthalmitis, eye irritation, eye pain, intraocular inflammation, retinal detachment, retinal pigment epithelial tear, retinal vascular occlusion, retinal vasculitis, vitreous floater

Misc: hypersensitivity reactions

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

None reported

Route/Dosage

Neovascular (wet) Age-Related Macular Degeneration

Intravitreal (Adults): 6 mg every 4 wk for four doses. Subsequent doses are individualized based on optical coherence tomography and visual acuity evaluations performed 8 and 12 wk later, and are administered as one of the following regimens:  Every 8-wk regimen: 6 mg on Weeks 20, 28, 36, and 44; or  Every 12-wk regimen: 6 mg on Weeks 24, 36, and 48; or  Every 16-wk regimen: 6 mg on Weeks 28 and 44. Some patients may require dosing every 4 wk following the initial 4 doses.

Diabetic Macular Edema

Intravitreal (Adults): Administer one of the following regimens:  Fixed interval regimen: 6 mg every 4 wk for six doses, followed by 6 mg every 8 wk; or  Variable interval regimen: 6 mg every 4 wk for at least four doses, followed by 6 mg every 4–16 wk (based on optical coherence tomography and visual acuity evaluations).

Macular Edema Following Retinal Vein Occlusion

Intravitreal (Adults): 6 mg every 4 wk for 6 mo.

Availability

Solution for intravitreal injection (vials and prefilled syringes): 120 mg/mL

Assessment

  • Assess eye for signs of infection frequently during wk following injection.
  • Check perfusion of optic nerve head immediately after injection; measure intraocular pressure prior to and 60 min following the injection.

Implementation

  • Discontinue treatment if patients develop retinal vasculitis and/or retinal vascular occlusion.
  • Intravitreal 

    For ophthalmic intravitreal injection only. Must be administered by a qualified physician.  For prefilled syringe, keep refrigerated in original carton to protect from light. Prior to use, bring to room temperature. Solution is clear to opalescent and colorless to brown-yellow. May be kept at room temperature for up to 24 hr. Inspect visually and do not use if contains particulates, is cloudy or discolored, or if packaging, syringe or filter needle are damaged or expired. Using aseptic technique, hold syringe by white collar and snap off cap (do not twist). Firmly attach provided injection filter needle onto syringe Luer lock. Hold syringe with needle pointing up, gently tap syringe until any air bubbles rise, and then slowly push plunger to set dose at 0.05 mL. Injection should be given immediately after preparation. For glass vial with transfer filter needle, storage and solution information provided above for the prefilled syringe applies to the vial. . To ensure all liquid settles at the bottom of vial, place upright on a flat surface for about 1 min. Gently tap, as liquid may stick to the top of the vial. Push the included 18-gauge × 1½ inch transfer filter needle all the way into the vial; then tilt slightly so the needle touches the bottom edge. Hold vial slightly inclined and slowly withdraw all liquid. Replace transfer needle with a 30-gauge × ½ inch injection needle. Expel contents until plunger tip is aligned with line marking 0.05 mL on syringe. Use each prefilled syringe or vial for the treatment of a single eye. Do not freeze or shake prefilled syringe or vial.

    • Immediately following intravitreal injection, monitor for elevation in intraocular pressure.

Patient/Family Teaching

  • Advise patient to notify ophthalmologist immediately if eye becomes red, sensitive to light, painful, or develops a change in vision.
  • May cause temporary visual disturbances. Caution patient to avoid driving or other activities requiring good eyesight until response to medication is known.
  • Rep:  May cause fetal harm. Advise females of reproductive potential to use highly effective contraception during and 3 mo after last dose. Advise females of reproductive potential to notify health care professional promptly if pregnancy is planned or suspected or if breastfeeding. May impair fertility.

Evaluation/Desired Outcomes

Decreased progression of visual loss.