ARVO 2024: Reduction in hard exudates with faricimab vs aflibercept in patients with DME

At this year's ARVO meeting, Roger Goldberg, MD, presented a paper on hard exudates and their resolution in patients with diabetic macular edema treated with either faricimab or 2 mg aflibercept.

Video Transcript:

Editor's note: The below transcript has been lightly edited for clarity.

Roger Goldberg, MD:

Hi, I'm Roger Goldberg from Bay Area Retina Associates in Walnut Creek, California. And I'm thrilled to be here at Seattle, ARVO 2024. Today, I presented data on hard exudates and their resolution in patients with diabetic macular edema treated with either faricimab or 2 mg aflibercept.

What we did is we looked at patients with hard exudates at baseline, which turned out was the vast majority of patients. And we looked to see what happened to those hard exudates at week 16, at year 1, and at year 2, based on color fundus photography, basically a binary question: presence or absence of hard exudates. And it turns out, first of all, amongst the patients with hard exudates at baseline, they tend to gain vision more slowly and have a slower reduction in their central subfield thickness on OCT.

Eventually, by years 1 and year 2, they do catch up to the cohort of patients who didn't have heart hard exudates at baseline. But I think we know clinically that patients with hard exudates, particularly subfoveal, hard exudates, those can be quite problematic for a patient's vision, even if the edema resolves with treatment. So week 16, comparing faricimab versus 2 mg aflibercept-treated eyes, we did not see any difference and frankly, not really much of a budge in the proportion of patients who had hard exudates at baseline. But when we look at years 1 and year 2, that's when we start to see separation in both the Q8[W]-treated faricimab eyes as well as the treat and extend eyes that got significantly fewer injections than the 2 Q8[W] or the faricimab Q8[W]-treated eyes. And overall we see about a 10% greater reduction in the proportion of patients with hard exudates in the faricimab-treated eyes than the 2 mg aflibercept eyes. We also previewed a little bit some data that's forthcoming looking at hard exudates on OCT as measured in picoliters.

And I think that's going to be very interesting because this was just a binary analysis: yes or no in terms of hard exudatespresence, but we know that of course there's a spectrum or a scale. And so stay tuned in a forthcoming congress, looking at resolution of hard exudates as measured by OCT and a volume-based measurement.