Faricimab
Overview
Faricimab is a humanized bispecific monoclonal antibody developed for the treatment of retinal vascular diseases characterized by abnormal blood vessel growth and increased vascular permeability. It simultaneously targets vascular endothelial growth factor A (VEGF-A) and angiopoietin-2 (Ang-2), two key mediators involved in retinal neovascularization and inflammation. By inhibiting both pathways, faricimab reduces fluid leakage, stabilizes retinal blood vessels, and helps preserve visual function. The drug is administered directly into the eye through intravitreal injection, ensuring localized activity within retinal tissues while minimizing systemic exposure. Faricimab is clinically important because its dual mechanism may allow effective disease control with extended dosing intervals in some patients compared with earlier single-target therapies. Ongoing assessment of retinal anatomy and visual acuity is required to guide individualized treatment intervals and ensure sustained therapeutic benefit.
Background and Date of Approval
Faricimab was developed to address limitations of earlier anti-VEGF therapies by incorporating dual inhibition of VEGF-A and Ang-2 in a single molecule. This approach was designed to improve vascular stability and reduce treatment burden in chronic retinal diseases. The molecule received regulatory approval from the United States Food and Drug Administration in 2022 for the treatment of neovascular age-related macular degeneration and diabetic macular edema in adults. Additional approvals by international regulatory authorities followed, including authorization for macular edema secondary to retinal vein occlusion in several regions. Approval decisions were based on large phase clinical trials demonstrating improvements in visual acuity and retinal thickness with flexible dosing schedules.
Uses
Faricimab is indicated for the treatment of adult patients with neovascular (wet) age-related macular degeneration, a condition caused by abnormal blood vessel growth under the retina leading to vision loss. It is also approved for the treatment of diabetic macular edema, a complication of diabetes resulting in retinal swelling and impaired vision. In some regions, it is additionally indicated for macular edema due to retinal vein occlusion. Faricimab is used as monotherapy and is integrated into long-term ophthalmic management plans with regular monitoring.
Administration
Faricimab is administered as an intravitreal injection into the affected eye by a trained ophthalmologist under aseptic conditions. Treatment typically begins with a series of monthly injections during an initiation phase, after which dosing intervals may be extended based on individual disease activity and response. Maintenance dosing may occur every eight, 12, or up to 16 weeks in selected patients. Treatment duration is individualized and continues as long as clinical benefit is observed. Regular eye examinations, including retinal imaging and visual acuity testing, are essential components of dosing decisions.
Side Effects
Commonly reported side effects of faricimab are generally localized to the eye and include conjunctival hemorrhage, eye pain or discomfort, blurred vision, increased intraocular pressure, and mild intraocular inflammation. Transient irritation, tearing, or a sensation of a foreign body in the eye may also occur following injection. These effects are often manageable and may resolve with observation or supportive care, but persistent symptoms should be evaluated by an eye care professional.
Warnings
Serious ocular adverse events associated with intravitreal faricimab include endophthalmitis, retinal detachment, retinal vascular occlusion, and severe intraocular inflammation, all of which may lead to permanent vision loss if not promptly treated. Rare systemic arterial thromboembolic events have been reported with intravitreal anti-angiogenic therapies, although causality is not fully established. Faricimab should not be administered in the presence of active ocular or periocular infection. Use during pregnancy may pose a risk to the fetus, and effective contraception is advised for individuals of reproductive potential during treatment.
Precautions
Baseline ophthalmic evaluation is required prior to initiating faricimab to rule out infection or active inflammation. Intraocular pressure and retinal status should be assessed at each visit. Patients should be instructed to report symptoms such as worsening vision, eye pain, redness, or floaters immediately. Systemic drug interactions are considered unlikely due to local ocular administration, but overall cardiovascular risk should be considered in patients with a history of thromboembolic disease. Temporary visual disturbances after injection may affect the ability to drive or operate machinery.
Expert Tips
Ensure patients understand the chronic nature of retinal vascular diseases and the importance of adherence to scheduled injection visits. Educate patients on recognizing warning signs of serious ocular complications that require urgent evaluation. Maintain strict aseptic technique during administration and monitor intraocular pressure after each injection. Coordinate care with retina specialists and primary care providers, particularly for patients with diabetes or cardiovascular risk factors. Discuss potential for extended dosing intervals once disease stability is achieved.