Faricimab (Vabysmo) is a bispecific antibody targeting vascular endothelial growth factor (VEGF) and angiopoietin-2 (Ang-2). It is indicated for the treatment of neovascular (wet) age-related macular degeneration (nAMD), diabetic macular edema (DME), and macular edema secondary to retinal vein occlusion (RVO).
Precautions for Administration of Faricimab (Vabysmo)
Administration Method
Administration Route: For intravitreal injection only and must be administered by a professional physician. Intravenous injection or rapid bolus injection is prohibited.
Preparation Selection: Two dosage forms are available—prefilled syringes and single-dose vials. Each contains 6 mg (0.05 mL of a 120 mg/mL solution) and is for single-eye use only. If the contralateral eye requires treatment, a full set of sterile devices must be replaced.
Contraindicated Populations
Patients with active ocular or periocular infections (e.g., conjunctivitis, endophthalmitis).
Patients with active intraocular inflammation (e.g., uveitis).
Patients with known hypersensitivity to faricimab or its excipients (which may present as rash, severe intraocular inflammation, etc.).
Pretreatment and Operational Specifications
Anesthesia and Disinfection: The procedure must be performed under sterile conditions, including surgical hand disinfection, sterile gloves, eyelid speculums, etc. A broad-spectrum antibacterial agent should be used before the operation.
Preventive Measures: Transient increase in intraocular pressure may occur within 60 minutes after injection. A sterile puncture needle must be prepared for emergency pressure reduction if needed.
Preparation Handling: Store under refrigeration (2°C–8°C). Before use, allow it to reach room temperature (20°C–25°C); freezing or shaking is strictly avoided.
The prefilled syringe must be used with the accompanying 30G filter needle. Before injection, expel all air bubbles and calibrate to the 0.05 mL mark.
Administration in Special Populations
Pregnancy and Lactation: Animal studies have shown embryotoxicity; the drug is contraindicated during pregnancy. Women of childbearing age must use contraception for 3 months after the last dose, and men must use contraception for 4 months after the last dose.
The safety of the drug during lactation is unknown; the risks and benefits should be carefully weighed.
Elderly Patients and Those with Hepatic/Renal Impairment: No dosage adjustment is required for patients aged ≥65 years, but close monitoring is necessary. Patients with mild to severe renal impairment also do not require dosage adjustment, while data on patients with severe impairment are limited.
Medication Monitoring for Faricimab (Vabysmo)
Infection and Inflammation Monitoring
Endophthalmitis/Retinal Detachment: Although the incidence is low, the consequences are severe. Vigilance is required for symptoms such as sudden vision loss, eye pain, and redness; prompt intervention is necessary.
Retinal Vasculitis/Vascular Occlusion: Rare but requires drug discontinuation; monitor changes in visual acuity.
Intraocular Pressure Increase: Transient elevation is common within 60 minutes after injection. Monitor optic nerve perfusion and perform puncture for pressure reduction if necessary.
Systemic Risks: The incidence of arterial thrombotic events (e.g., stroke, myocardial infarction) is comparable to that of control drugs, but attention should be paid to the potential risks of VEGF inhibitors.
Follow-Up Frequency
nAMD: Initial treatment involves 4 monthly injections; subsequent intervals are adjusted based on OCT and visual acuity assessments (every 8–16 weeks).
DME: At least 4 monthly injections are required; after edema remission, the interval can be extended to every 8 weeks, and some patients may need to maintain monthly administration.
RVO: Fixed monthly injections for 6 consecutive months.
Examination Items
OCT: Regularly measure central subfield thickness (CST) to assess the resolution of edema.
Visual Acuity Test: Use the ETDRS (Early Treatment Diabetic Retinopathy Study) chart to monitor best-corrected visual acuity (BCVA).
Intraocular Pressure and Fundus Examination: Monitor intraocular pressure and retinal structure after each injection.
Patient Education and Long-Term Management
Symptom Reporting: Instruct patients to record abnormal symptoms such as eye pain, blurred vision, and flashes of light, and seek medical attention promptly.
Follow-Up Requirements: Regular assessments are necessary even in the absence of symptoms, and monitoring should continue for several months after drug discontinuation.
