Efficacy of Initial Intravitreal Faricimab Injection after Switching from Aflibercept to Faricimab in Treatment-Resistant Neovascular Age-Related Macular Degeneration.

INTRODUCTION

Previous studies have demonstrated the efficacy of faricimab where the intervention in treatment-resistant neovascular age-related macular degeneration (nAMD) had been switched from aflibercept to faricimab. This exploratory study aimed to assess the clinical, anatomical, and functional outcomes of a single intravitreal faricimab injection in those with treatment-resistant nAMD who switched from aflibercept, in a single tertiary ophthalmology center.

METHODS

This retrospective, observational, real-world study assessed 20 patients (21 eyes) with treatment-resistant nAMD who were switched from intravitreal aflibercept (2.0 mg/0.05 mL) to faricimab (6.0 mg/0.05 mL) due to persistent subretinal fluid (SRF) despite frequent Aflibercept injections. Patients were switched to a regimen of faricimab consisting of three loading doses administered at 4-weekly injections. Anatomical and functional measures were assessed at two time points: immediately before the initial faricimab injection and approximately 4 weeks later, before the second faricimab injection. The outcome measures, namely visual acuity, central macular thickness (CMT), macular volume, and the presence of SRF, were evaluated pre- and post-switch.

RESULTS

Twenty-one eyes from 20 patients were analyzed. Statistically significant reductions in CMT (from 570.2 to 482.7 μm; p < 0.01) and macular volume (from 8.57 to 7.87 mm3; p = 0.02) were observed post-switch, while the change in visual acuity did not reach statistical significance (p = 0.051). The number of eyes with SRF decreased from 21 pre-switch to 9 post-switch.

CONCLUSION

The findings from this exploratory study suggest that switching from aflibercept to faricimab demonstrated significant physiological improvements among patients with treatment-resistant nAMD. Faricimab may serve as an effective and safe option in this patient population. The exploratory study also identifies changes in CMT and macular volume as outcome measure candidates for future large-scale investigations.