Anti-VEGF and Anti-Ang-2 — Bispecific Monoclonal Antibody Pregnancy: Avoid — VEGF inhibition may affect fetal development

Faricimab (Intravitreal)

Brand names: Vabysmo

Adult dose

Dose: 6 mg intravitreal injection

Route: Intravitreal injection

Frequency: Monthly × 4 loading doses, then every 8–16 weeks based on treat-and-extend protocol

Max: 6 mg per injection

First bispecific antibody for ocular use — dual VEGF-A and Ang-2 inhibition. Licensed for neovascular age-related macular degeneration (nAMD) and diabetic macular oedema (DME). Treat-and-extend protocol allows up to 16-weekly injections in responding patients — significant burden reduction vs monthly anti-VEGF.

Paediatric dose

Route:

Not licensed for paediatric use

Dose adjustments

Renal

No systemic dose adjustment — intravitreal administration

Hepatic

No adjustment

Clinical pearls

TENAYA and LUCERNE trials (Lancet 2022): faricimab non-inferior to aflibercept for nAMD at year 1; 45% of faricimab patients maintained IOP control on every-16-week dosing — significantly reduces injection burden vs monthly ranibizumab
YOSEMITE and RHINE trials: faricimab superior to quarterly aflibercept and non-inferior to monthly aflibercept for DME — 51–53% of patients on every-16-week dosing
Dual mechanism: VEGF-A drives neovascularisation; Ang-2 destabilises blood vessels and promotes angiogenesis synergistically; inhibiting both pathways provides broader vascular control than VEGF alone
NICE TA924 (2023): faricimab recommended for nAMD as alternative to ranibizumab and aflibercept — NHS approved; cost-effective due to extended dosing intervals reducing treatment burden
Treat-and-extend protocol: after loading phase (4 monthly injections), extend by 4-week increments to maximum 16 weeks; if fluid recurs, shorten interval; individualised dosing is the key advantage

Contraindications

Active ocular or periocular infection
Active intraocular inflammation
Hypersensitivity to faricimab

Side effects

Conjunctival haemorrhage (most common — injection-related)
Increased IOP transiently post-injection
Ocular discomfort
Endophthalmitis (rare — risk ~1:1000–3000 per injection)
Retinal detachment
Arterial thromboembolic events (rare — systemic VEGF inhibition)

Interactions

No clinically significant systemic drug interactions — intravitreal dosing; minimal systemic exposure

Monitoring

OCT (optical coherence tomography) at each visit — central retinal thickness and subretinal fluid
Visual acuity
IOP at each visit
Signs of endophthalmitis post-injection (patients must return if eye becomes red or vision worsens)

Reference: BNFc; BNF 90; NICE TA924; TENAYA/LUCERNE Trials (Lancet 2022); YOSEMITE/RHINE Trials; SPC Vabysmo. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways