Faricimab (Vabysmo) is a bispecific antibody that simultaneously inhibits vascular endothelial growth factor (VEGF) and angiopoietin-2 (Ang-2). It is indicated for the treatment of neovascular (wet) age-related macular degeneration (nAMD), diabetic macular edema (DME), and macular edema secondary to retinal vein occlusion (RVO).
How to Use Faricimab (Vabysmo)
Administration Route and Frequency
Faricimab is for intravitreal injection only and must be administered by a qualified physician.
The recommended dose is 6 mg (0.05 mL of a 120 mg/mL solution), with variations in administration frequency depending on the indication.
Drug Preparation
Prefilled Syringe: Contains a 30G × 1/2-inch ultra-thin wall injection filter needle with an integrated filter. Before use, allow it to reach room temperature (20–25°C / 68–77°F) and check that the solution is clear to opalescent and colorless to tan.
Vial: Use the accompanying 18G × 1½-inch blunt transfer filter needle to withdraw the drug solution, then replace it with a 30G × 1/2-inch injection needle.
Strict aseptic technique must be followed during preparation, and the prepared drug should be used immediately.
Dosage Adjustment of Faricimab (Vabysmo)
Principles of Dosage Adjustment
Dosage adjustment of faricimab is mainly based on the severity of adverse reactions.
The peak therapeutic effect may take 4–6 weeks to appear, so dosage adjustments should not be made too frequently.
Interstitial Lung Disease/Pneumonitis (ILD/Pneumonitis)
Asymptomatic (Grade 1): Suspend administration until complete resolution.
Symptomatic (Grade ≥2): Discontinue administration permanently.
Ocular Adverse Reactions
Non-confluent superficial keratitis: Suspend administration until improvement.
Confluent superficial keratitis or visual acuity decrease of ≥3 lines: Suspend administration and reduce the dose by one level.
Corneal ulcer or stromal opacity: Discontinue administration permanently.
Administration of Faricimab (Vabysmo) in Special Populations
Elderly Patients
In clinical studies, approximately 58% of patients were ≥65 years old. No significant difference in efficacy was observed between elderly patients and younger patients, so no dosage adjustment is required.
Patients with Renal Impairment
Patients with mild to moderate renal impairment (creatinine clearance [CLcr] 30–<90 mL/min) do not require dosage adjustment, but the incidence of ILD/pneumonitis may increase, requiring close monitoring.
Data on patients with severe renal impairment (CLcr <30 mL/min) are not yet clear.
Patients with Hepatic Impairment
Patients with mild hepatic impairment (total bilirubin ≤ upper limit of normal [ULN] with any elevated AST, or total bilirubin >1–1.5×ULN with any AST): No dosage adjustment is required.
Patients with moderate hepatic impairment (total bilirubin >1.5–3×ULN with any AST): Closely monitor for adverse reactions.
Patients with severe hepatic impairment (total bilirubin >3×ULN with any AST): The recommended dose has not been established.
Pregnant and Lactating Women
Pregnancy: Based on animal study data, faricimab may cause harm to the fetus.
Women of childbearing age should confirm their pregnancy status before treatment and use effective contraceptive measures during treatment and for 7 months after the last dose.
Lactation: There is no data on whether faricimab is excreted in human milk. It is recommended to discontinue breastfeeding during treatment and for 1 month after the last dose.
