Опыт применения препарата фарицимаб при неоваскулярной форме возрастной макулярной дегенерации

Abstract

The purpose of the study was to evaluate the effectiveness and safety of a novel antiVEGF agent faricimab in patients with neovascular age-related macular degeneration (nAMD) in real-world clinical practice. Material and methods. It was a retrospective study including 66 patients (68 eyes) with nAMD treated at our center from August to December 2023. The follow-up period ranged from two to four months. Group 1 included 10 treatment-naïve patients (10 eyes) who received monthly loading intravitreal faricimab injections 0.05 mL (6 mg). A total of 32 injections were performed (mean number of injections per eye = 3.2 ± 0.8). Group 2 included 57 patients (58 eyes) who were previously treated with other anti-VEGF agents using treat-and-extend (TAE) approach. They were switched to faricimab, and a total of 136 injections (mean number of injections per eye = 2.3 ± 1.0) were performed. Optical coherence tomography (OCT) was used to assess the central retinal thickness (CRT), the presence of subretinal fluid (SRF) and intraretinal fluid (IRF), the sub-retinal pigment epithelium (RPE) fluid, as well as changes over time in the pigment epithelial detachment (PED) in all patients. Results. In Group 1, the baseline CRT was 320.8 ± 37.0 µm and significantly decreased after the second injection to 232.5 ± 44.1 µm (р = 0.012). IRF, SRF and sub-PED fluid at the baseline were present in 90.0%, 90.0%, and 70.0% of the eyes, respectively. After the second injection, these proportions decreased to 0.0%, 0.0%, and 22.2%, respectively (p < 0.01). After the second faricimab injection, the PED completely resolved in 50 % (n=5) of Group 1 eyes, and the rest of the eyes showed decreased PED. In Group 2, the baseline CRT value was 287.6 ± 79.3 µm and significantly decreased to 241.2 ± 42.3 µm (p < 0.001). At the time of switching, IRF, SRF and sub-PED fluid at the baseline were present in 37.9%, 57.2%, and 13.8%, respectively. However, after switching, there was a decrease only in the IRF accumulation (17.2 %; p = 0.03), while the proportions of eyes with the SRF and the sub-PED fluid did not change significantly and were 43.1 % (р = 0.08) and 10.3 % (p = 0.69), respectively. In most eyes (63.1 %), there were no changes in PED condition over time. Conclusion. Treatment-naïve patients with nAMD receiving loading therapy with faricimab demonstrated significant improvement of all anatomic parameters, while antiVEGF-treated patients tended to demonstrate improvement in some parameters. Further long-term studies are needed to assess the functional outcomes of faricimab treatment, a possibility to extend the inter-injection intervals, and to compare the effectiveness and safety of this drug with other anti-VEGF agents. Keywords: age-related macular degeneration, anti-VEGF therapy, faricimab, optical coherence tomography