What is Vabysmo therapy?
Vabysmo therapy (pronounced, “vah-BYE-smo”) is a treatment for wet-type macular degeneration and diabetic macular edema. It involves repeated injections of medication into the eye to stop abnormally leaky blood vessels. Vabysmo is the trade name of the medication and faricimab is the research/generic name. On January 28, 2022, the FDA approved Vabysmo for use in the United States based on standard phase 3 study results (Yosemite/Rhine Studies for diabetic macular edema and Tenaya/Lucerne Studies for wet macular degeneration).
How effective is Vabysmo therapy?
Vabysmo may last longer than other drugs currently available to treat these conditions. However, it has been my experience that Vabysmo offers little additional benefit in diabetic macular edema. I currently prefer Lucentis in patients treated for diabetic macular edema.
In wet-type macular degeneration (wAMD), Vabysmo does appear to last longer than other currently approved medications in some patients. However, there appears to be an increased risk of loss of vision from RPE tear in patients with serous retinal pigment epithelial detachment in the setting of age-related macular degeneration.
What are the risks of Vabysmo therapy?
Severe complications are very rare, but risks of Vabysmo injection include bleeding, infection, retinal detachment, glaucoma, cataract, and loss of vision/loss of the eye. The risk of retinal detachment is about 1 in 5,000 injections, but the visual results are poor despite surgical repair. In initial studies there appeared to be a low risk (1.8%) of stroke with this type of therapy. The risk of stroke may be related to the older age of patients in which it is used. Further investigation will provide more information. Non-infectious inflammation is less common with Vabysmo than brolucizumab (Beovu), another drug that offered drug treatment at reduced intervals. Although rare, inflammation did occur in Vabysmo (1-2% of cases) more than twice as often as it did with Eylea (1% or less). Pregnancy should be avoided while on Vabysmo therapy.
What do I expect after a Vabysmo injection?
Be careful not to rub the eye after the injection because the eye may remain anesthetized for several hours. You may be given eye drops and instructions on how to use them. Physical activity is not limited after the injection. Tylenol or Ibuprofen may be used if there is discomfort, but severe pain should be reported to your doctor without delay. It is normal to experience a red area on the white of the eye, which disappears in one to two weeks. If you have any questions or concerns, please call the office.
UPDATE October 2022: I have been using Vabysmo in the office. I am pleased with the results in patients with wet AMD in that I can extend the treatment interval further than with older drugs. These findings are in concert with a recent two-year report of the Tanaya Study at the American Academy of Ophthalmology. However, patients with large serous pigment epithelial detachments (PED) appear to be at greater risk of vision loss from rips in the PED. In contrast to eyes with macular degeneration, I have not been impressed with superior effectiveness of Vabysmo in patients with diabetic retinopathy.
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