Faricimab
JFDA label: Vabysmo 120mg /ml solution for intravitreal injection
Mechanism of Action
Inhibitor of Angiopoietin-2 — Angiopoietin-2 inhibitor; Inhibitor of Vascular endothelial growth factor A, long form — Vascular endothelial growth factor A inhibitor
| Target | Action | Gene / class |
|---|---|---|
| Angiopoietin-2 efficacy | INHIBITOR | ANGPT2 · Secreted protein |
| Vascular endothelial growth factor A, long form efficacy | INHIBITOR | VEGFA · Secreted protein |
Indications
Approved
- Diabetes Complications — macrovascular complications of diabetes
- Macular Edema — macular retinal edema
- Retinal Neovascularization — ocular vascular disease
- Wet Macular Degeneration — wet macular degeneration
Off-label
- Choroidal Neovascularization
- Macular Degeneration
Contraindications
Source: openFDA
- Ocular or periocular infection ( 4.1 ) Active intraocular inflammation ( 4.2 ) Hypersensitivity ( 4.3 ) 4.1 Ocular or Periocular Infections VABYSMO is contraindicated in patients with ocular or periocular infections. 4.2 Active Intraocular Inflammation VABYSMO is contraindicated in patients with active intraocular inflammation. 4.3 Hypersensitivity VABYSMO is contraindicated in patients with known hypersensitivity to faricimab or any of the excipients in VABYSMO. Hypersensitivity reactions may manifest as rash, pruritus, urticaria, erythema, or severe intraocular inflammation. Absolute
Dosing
Source: openFDA
Warnings & Precautions
Source: openFDA
Warnings & Precautions
Endophthalmitis and retinal detachments may occur following intravitreal injections. Patients should be instructed to report any symptoms suggestive of endophthalmitis or retinal detachment without delay, to permit prompt and appropriate management. ( 5.1 ) Increases in intraocular pressure have been seen within 60 minutes of an intravitreal injection. ( 5.2 ) There is a potential risk of arterial thromboembolic events (ATEs) associated with VEGF inhibition. ( 5.3 )
Endophthalmitis and Retinal Detachments Intravitreal injections, inclu
Endophthalmitis and Retinal Detachments Intravitreal injections, including Vabysmo, have been associated with endophthalmitis and retinal detachments [see Adverse Reactions (6.1) ] . Proper aseptic injection techniques must always be used when administering VABYSMO. Patients should be instructed to report any signs or symptoms suggestive of endophthalmitis or retinal detachment without delay, to permit prompt and appropriate management [see Dosage and Administration (2.6) and Patient Counseling Information (17) ].
Increase in Intraocular Pressure Transient increases in intraocular pr
Increase in Intraocular Pressure Transient increases in intraocular pressure (IOP) have been seen within 60 minutes of intravitreal injection, including with VABYSMO [see Adverse Reactions (6.1) ]. IOP and the perfusion of the optic nerve head should be monitored and managed appropriately [see Dosage and Administration (2.6) ].
Thromboembolic Events Although there was a low rate of arterial thromb
Thromboembolic Events Although there was a low rate of arterial thromboembolic events (ATEs) observed in the VABYSMO clinical trials, there is a potential risk of ATEs following intravitreal use of VEGF inhibitors. ATEs are defined as nonfatal stroke, nonfatal myocardial infarction, or vascular death (including deaths of unknown cause). The incidence of reported ATEs in the nAMD studies during the first year was 1% (7 out of 664) in patients treated with VABYSMO compared with 1% (6 out of 662) in patients treated with aflibercept [see Clinical Studies (14.1) ] . The incidence of reported ATEs in the DME studies from baseline to week 100 was 5% (64 out of 1,262) in patients treated with VABYSMO compared with 5% (32 out of 625) in patients treated with aflibercept [see Clinical Studies (14.2) ] . The incidence of reported ATEs in the RVO studies during the first 6 months was 1.1% (7 out of 641) in patients treated with VABYSMO compared with 1.4% (9 out of 635) in patients treated with aflibercept [see Clinical Studies (14.3) ] .
Retinal Vasculitis and/or Retinal Vascular Occlusion Retinal vasculiti
Retinal Vasculitis and/or Retinal Vascular Occlusion Retinal vasculitis and/or retinal vascular occlusion, typically in the presence of intraocular inflammation, have been reported with the use of VABYSMO [see Adverse Reactions (6.2) ] . Discontinue treatment with VABYSMO in patients who develop these events. Patients should be instructed to report any change in vision without delay.
Pregnancy & Lactation
Lactation
Waiting for at least 2 weeks postpartum to resume therapy may minimize
Chemistry & Properties
| Formula | C25H30ClN3O2 |
|---|---|
| Molecular weight | 440.0 g/mol |
| IUPAC name | [6-chloro-1-[2-(dimethylamino)ethyl]-2,3-dihydroindol-3-yl]-spiro[1H-2-benzofuran-3,4'-piperidine]-1'-ylmethanone |
| CAS | 1607793-29-2 |
| PubChem CID | 91827367 |
| InChIKey | DRMVDBATNZBNEB-UHFFFAOYSA-N |
| logP | 3.2 (XLogP 3.2) |
| Polar surface area | 36.0 Ų |
| H-bond acceptors / donors | 4 / 0 |
SMILES
CN(C)CCN1CC(C2=C1C=C(C=C2)Cl)C(=O)N3CCC4(CC3)C5=CC=CC=C5CO4Biology & Pharmacokinetics
Pharmacokinetics predicted
| Bioavailability | 70.0% |
|---|---|
| Half-life | 0.48 h |
| Volume of distribution | 5.87 L/kg |
| Protein binding | 92.6% |
| BBB penetrant | Yes |
Enzyme interactions
| Enzyme | Role | Detail |
|---|---|---|
| CYP1A2 | Substrate | — |
| CYP2C19 | Substrate | — |
| CYP2D6 | Inhibitor | — |
| CYP3A4 | Substrate | — |
Transporters
BCRP (Inhibitor)BSEP (Inhibitor)MRP1 (Inhibitor)OATP1B1 (Inhibitor)OATP1B3 (Inhibitor)P-gp (Inhibitor)P-gp (Substrate)
Registered Products (1)
| Brand | Form / strength | Pack | Agent | Citizen (JOD) |
|---|---|---|---|---|
| Vabysmo 120mg /ml solution for intravitreal injection | Injection 120 mg/ml (28.8 mg/0.24 ml) Single Dose 6 mg/0.05 ml | 1 vial | Shawi & Rushedat Drug Store | — |