Outcomes of Treatment-Resistant Neovascular Age-Related Macular Degeneration Switched from Aflibercept to Faricimab

Abstract

PurposeWhile previous studies have demonstrated the efficacy of Faricimab in treatment-naïve nAMD patients, its outcomes in patients switched from Aflibercept are less understood. This study aimed to assess real world anatomical and functional outcomes of switching to Faricimab in patients undergoing Aflibercept intravitreal injections for nAMD with sub-optimal response. DesignRetrospective case series. SubjectsPatients with nAMD at a single tertiary care center who were switched from Aflibercept to Faricimab due to persistent suboptimal response. MethodsPatients had received a minimum of 6 consecutive intravitreal injections of aflibercept and showed persistent presence of intraretinal or subretinal fluid on OCT despite receiving aflibercept at 4 or 6-weekly intervals at the time of the switch. Patients receiving 4-weekly aflibercept were either switched with 2 or 3 loading doses of 4-weekly Faricimab injections.. Regression models were used to identify predictors of clinical outcomes. Main Outcome MeasuresVisual acuity, central macular thickness, and OCT parameters were assessed pre- and post-switch ResultsEighty-one eyes of 68 patients were included. The mean age was 79.1 years (SD: 8.9), and females constituted 53% of cases. A statistically significant reduction in central macular thickness was observed post-switch (p<0.0001). The proportion of cases with intraretinal (p=0.0219) and subretinal fluid (p<0.000) decreased significantly. Overall clinical improvement on OCT was noted in 80% of patients. No significant improvement in ETDRS vision was observed. There was no evidence that switching regimen (2 vs. 3 loading doses) had an independent effect on clinical outcomes. ConclusionAmongst patients with treatment-resistant nAMD, switching from Aflibercept to Faricimab may serve as a safe and effective option. Significant anatomical improvements were observed, with a trend towards visual stability. The loading regimen with two Faricimab injections appeared to be sufficient for non-naïve patients. However, a longer follow-up and larger studies are warranted to confirm these findings.