Intravitreal Aflibercept and Faricimab decreases ocular blood flow to optic nerve head and peripapillary retinal vessels: Study
Diabetic retinopathy (DR) is the primary cause of visual impairment among working-age populations in industrialized nations. Vision loss may result from various mechanisms, but the most prevalent cause is diabetic macular edema (DME). The treatment landscape for DME has advanced significantly over the past decade. Currently, the most frequently employed therapeutic approach involves intravitreal administration of anti-vascular endothelial growth factor (VEGF) agents, and the prognosis of patients with DME has markedly improved. There are various commercially available anti-VEGF agents. Older options include monoclonal antibodies such as ranibizumab and bevacizumab. While ranibizumab and bevacizumab alone inhibit VEGF-A, aflibercept, a recombinant fusion protein, inhibits VEGF-A, VEGF-B, and placental growth factor (Plgf), and faricimab, a bispecific antibody, inhibits both VEGF-A and angiopoietin-2 (Ang-2).
Laser speckle flowgraphy (LSFG) facilitates two-dimensional, non-invasive measurements of perfusion at the optic nerve head (ONH), retina, and choroid by utilizing the laser speckle phenomenon and has proven instrumental in quantifying ocular blood flow in patients with DR, retinal vein occlusion, age-related macular degeneration, or central serous chorioretinopathy. In this study, authors aimed to evaluate and compare the effects of intravitreal aflibercept (IVA) versus intravitreal faricimab (IVF) on blood flow in the optic nerve head and retinal vessels of the peripapillary region using LSFG in patients with DME. This was the first study to investigate the effect of intravitreal faricimab on ocular perfusion and compare the effects of different anti-VEGF agents on ocular blood flow one month after injection.
This study included 20 eyes of 18 patients treated with IVA and 15 eyes of 11 patients treated with IVF for DME. The mean blur rate (MBR) of the ONH and retinal artery and vein of the peripapillary region were measured using LSFG at baseline and 1 month after injection. Central retinal thickness (CRT) and best-corrected visual acuity (BCVA) were measured for all patients.
CRT decreased significantly in both IVA-treated (p = 0.0003) and IVF-treated groups (p = 0.0004). Some of the MBR-related parameters of the ONH, such as MBR of all areas (MA), MBR of vascular areas (MV), and MBR of tissue areas (MT), decreased significantly 1 month after IVA and IVF compared to baseline values (MA of IVA, p < 0.0001; MT of IVA, p = 0.0220; MA of IVF, p = 0.0002; MT of IVF, p = 0.0461). MBR of the retinal artery (MBR-A) and vein (MBR-V) also decreased significantly 1 month after IVA and IVF compared with baseline values (MBR-A of IVA, p = 0.0002; MBR-V of IVA, p = 0.0010; MBR-A of IVF, p = 0.0368). No significant difference in ocular perfusion was observed between the IVA-treated and IVF-treated groups.
In conclusion, the findings demonstrated that both IVA and IVF resulted in a decrease in ocular blood flow to the optic nerve head and peripapillary retinal vessels, as evaluated using the LSFG. This decrease was associated with a reduction in CRT and improvement in BCVA. No significant difference was observed in MBR reduction between the IVA-treated and IVF-treated groups. Study findings warrant further long-term investigations to reveal differences in ocular circulation modifications between aflibercept and faricimab.
Source: Mizukami et al; Clinical Ophthalmology 2024:18 https://doi.org/10.2147/OPTH.S476307
