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Faricimab bispecific antibody with Fab regions that bind to VEGF and Ang-2.


Faricimab (Vabysmo, Genentech, San Francisco, CA) is a combined-mechanism medication with simultaneous and independent binding[1] on both vascular endothelial growth factor A (VEGF-A) and angiopoietin-2 (Ang-2) that is approved for the treatment of diabetic macular edema and neovascular (wet) age-related macular degeneration.

Indications and Use

Faricimab has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of diabetic macular edema and wet age-related macular degeneration.

Mechanism of Action

Faricimab has an inhibitory effect on both VEGF-A and Ang-2 and is thought to have a longer-lasting effect than previous anti-VEGF agents in clinical trials.

Anti-VEGF therapy has been employed in the treatment of retinal vascular disease, however their effectiveness is limited by the role of VEGF in the pathogenesis.[2] Exploration of alternative targets has revealed the role of angiopoietin (Ang), whose two isoforms Ang-1 and Ang-2 bind to tyrosine kinase (Tie-2) endothelial receptors to regulate vasculogenesis.[2] Ang-1 is an agonist of Tie-2 with constitutive vessel-stabilizing effects,[3] but Ang-2 is an antagonist which inhibits its phosphorylation and has been shown to play a role in cytokine-induced vascular leakage.[3].  Ang-2-deficient (Ang-2-/-) mice even demonstrate a diminished vascular response to VEGF.[3]

The use of monoclonal antibodies in anti-VEGF therapy presented an opportunity for targeting two mediators of retinal vascular disease with a single molecule.[2] These bispecific antibodies may be developed with CrossMAb (Roche, Basel, Switzerland), a proprietary technology that allows for two different antigen-binding domains (Fab) on the antibody.[4][5] CrossMAb was used in the development of faricimab, originally known as RG7716.[2]

Administration and Dosing

Faricimab is given as an intravitreal injection at a dose of 6 mg from 0.05 mL of a 120 mg/mL solution.[6] For neovascular age-related macular degeneration, one regimen is 6 mg intravitreal every 4 weeks for the first 4 doses, then the same dose either 8 or 12 weeks later depending on findings of optical coherence tomography and visual acuity evaluations. [1]

For diabetic macular edema, faricimab is injected every 4 weeks for the first 4 doses. Afterwards, a personalized treatment interval similar to treat and extend may be implemented. The dosing interval may then be adjusted based on the response of macular edema as measured by optical coherence tomography.[6] Alternatively, a 6 mg intravitreal injection can be administered every 4 weeks for the first 6 doses, followed by a an injection every 8 weeks over the next 28 weeks.[6]


Faricimab is a 120 mg/mL solution in a single-dose vial that should be refrigerated prior to use.[6] Each vial contains more solution than necessary for administration of a single 0.05 mL dose of solution containing 6 mg of faricimab.[6] Before injection, the eye should be anesthetized with topical anesthetic and cleansed with betadine. The contents of the faricimab vial should be drawn using the provided 18 gauge needle. The 18 gauge needle should then be replaced with a sterile 30 gauge ½ inch needle for the injection.[6]

Clinical Trials

Faricimab has been the subject of multiple clinical trials to evaluate its safety and efficacy. BOULEVARD and STAIRWAY are phase II clinical trials of faricimab for diabetic macular edema (DME) and neovascular age-related macular degeneration (nAMD), respectively.[2][1] RHINE and YOSEMITE are phase III trials of faricimab in DME.[2] TENAYA and LUCERNE are phase III trials of faricimab in nAMD.[2][7]


BOULEVARD is a phase II, 36-week, double-blind, randomized, active comparator controlled, multicenter trial of 229 treatment-naïve patients with DME.[2][8] Patients were randomized into one of three cohorts: 6.0 mg faricimab, 1.5 mg faricimab, or 0.3 mg ranibizumab. Patients were treated Q4W for 20 weeks. Primary endpoint outcomes were measured at 24 weeks and followed until 36 weeks.[2] The 6.0 mg faricimab cohort demonstrated superior letter gains in visual acuity, central subfield thickness reduction, and diabetic retinopathy severity score (DRSS) improvement. The findings suggested a benefit in visual gain and potential for extended durability[9] of simultaneous inhibition of Ang-2 and VEGF-A in patients with DME.[8]


STAIRWAY is a phase II, 52-week randomized, active comparator controlled, parallel-group, multicenter study that evaluated 76 patients with nAMD on Q12W or Q16W dosing schedules after a loading dose of four montly injections of faricimab compared to ranibizumab 0.5 mg Q4W.[1] Faricimab administered Q12W or Q16W after a loading dose demonstrated vision and anatomic improvement comparable to Q4W ranibizumab.[1]


YOSEMITE and RHINE are identically designed phase III clinical trials of faricimab in treatment-naive and previously anti-VEGF treated patients with center-involving diabetic macular edema.[9] The studies compared faricimab Q8W after 6 initial Q4W doses, faricimab personalized treatment interval (PTI) after 4 initial Q4W doses, and aflibercept Q8W after 5 initial Q4W doses.[9] PTI is based on treat-and-extend and uses prespecified best-corrected visual acuity (BCVA) and central subfield thickness (CST) criteria.[9] The primary efficacy endpoint is the mean change in BCVA from baseline averaged over weeks 48, 52, and 56. One-year results were presented at ARVO 2021.[9]


TENAYA and LUCERNE are identical, phase III, randomized, double-masked, active comparator-controlled, 112-week studies of faricimab in neovascular AMD.[7] Patients were randomized to receive either faricimab or aflibercept during the study period.[7] The primary efficacy endpoint was mean change in best-corrected visual acuity (BCVA) from baseline averaged over weeks 40, 44, and 48.[7] Secondary endpoints included the proportion of patients on faricimab Q16W, Q12W, and Q8W regimens, proportion of patients gaining ≥15 or ≥10 ETDRS letters from baseline, and chnages from baseline in anatomic outcomes.[7] Safety outcomes included incidence and severity of ocular and nonocular adverse events.[7] One-year results were presented at ARVO 2021.[7]


  1. 1.0 1.1 1.2 1.3 1.4 Khanani AM, Patel SS, Ferrone PJ, et al. Efficacy of Every Four Monthly and Quarterly Dosing of Faricimab vs Ranibizumab in Neovascular Age-Related Macular Degeneration: The STAIRWAY Phase 2 Randomized Clinical Trial. JAMA Ophthalmol. 2020;138(9):964–972. doi:10.1001/jamaophthalmol.2020.2699
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Sharma A, Kumar N, Kuppermann BD, Bandello F, Loewenstein A. Faricimab: expanding horizon beyond VEGF. Eye (Lond). 2020;34(5):802-804. doi:10.1038/s41433-019-0670-1
  3. 3.0 3.1 3.2 Benest AV, Kruse K, Savant S, Thomas M, Laib AM, Loos EK, Fiedler U, Augustin HG. Angiopoietin-2 is critical for cytokine-induced vascular leakage. PLoS One. 2013 Aug 5;8(8):e70459. doi: 10.1371/journal.pone.0070459. PMID: 23940579; PMCID: PMC3734283.
  4. Schaefer W, Regula JT, Bahner M, Schanzer J, Croasdale R, Durr H, et al. Immunoglobulin domain crossover as a generic approach for the production of bispecific IgG antibodies. Proc Natl Acad Sci USA. 2011;108:11187–92. doi: 10.1073/pnas.1019002108.
  5. Regula JT, Lundh von Leithner P, Foxton R, et al. Targeting key angiogenic pathways with a bispecific CrossMAb optimized for neovascular eye diseases [published correction appears in EMBO Mol Med. 2019 May;11(5):]. EMBO Mol Med. 2016;8(11):1265-1288. Published 2016 Nov 2. doi:10.15252/emmm.201505889
  6. 6.0 6.1 6.2 6.3 6.4 6.5 Vabysmo prescribing information - gene.com. https://www.gene.com/download/pdf/vabysmo_prescribing.pdf. Accessed April 17, 2022
  7. 7.0 7.1 7.2 7.3 7.4 7.5 7.6 Khanani AM, Heier J, Ruiz CQ, et al. Faricimab in neovascular age-related macular degeneration: 1-year efficacy, safety, and durability in the phase 3 Tenaya and Lucerne Trials. Investigative Ophthalmology & Visual Science. https://iovs.arvojournals.org/article.aspx?articleid=2772827. Published June 21, 2021. Accessed May 29, 2022.
  8. 8.0 8.1 Sahni J, Patel SS, Dugel PU, et al. Simultaneous Inhibition of Angiopoietin-2 and Vascular Endothelial Growth Factor-A with Faricimab in Diabetic Macular Edema: BOULEVARD Phase 2 Randomized Trial. Ophthalmology. 2019;126(8):1155-1170. doi:10.1016/j.ophtha.2019.03.023
  9. 9.0 9.1 9.2 9.3 9.4 Wells JA, Wykoff CC, Willis JR, et al. Efficacy, durability, and safety of faricimab in diabetic macular edema (DME): one-year results from the phase 3 YOSEMITE and RHINE trials. Investigative Ophthalmology & Visual Science. 2021;62(8):1037.
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