Short-Term Outcomes of Faricimab in Patients with Neovascular Age-Related Macular Degeneration on Prior Anti-VEGF Therapy

Abstract

A subset of patients with neovascular age related macular degeneration (nAMD) experience treatment burden and suboptimal response with anti-vascular endothelial growth factor (anti-VEGF) therapy. The aim of this study was to investigate the effect of switching to a novel bi-specific agent, faricimab, in patients with nAMD currently treated with anti-VEGF. Retrospective, non-comparative cohort study. Patients with nAMD previously treated with anti-VEGF and switched to intravitreal faricimab injection (IFI) at the Cleveland Clinic's Cole Eye Institute. Switching and administration schedule of IFI was at the discretion of the clinician. Visual acuity (VA) and macular optical coherence tomography (OCT) parameters, including central subfield thickness (CST), maximum pigment epithelial detachment (PED) height and presence of subretinal (SRF) or intraretinal fluid (IRF), were assessed at baseline (day of first IFI) and after each IFI. CST and presence of IRF or SRF after at least 3 IFI. 126 eyes of 106 patients were included in the analysis with a mean follow-up time of 24.3±5.2 weeks. Prior to switching to IFI, patients received a mean of either aflibercept (20.0±18.4, mean±SD), bevacizumab (7±8.9), ranibizumab (1.9±8.5), or brolucizumab (0.3±1.6) injections. The most common agent used prior to switching to IFI was aflibercept (n=110, 87%), and the mean treatment interval with any anti-VEGF of 5.6±1.6 weeks prior to switching. CST was reduced from baseline after the first IFI (266.8±64.7 vs 249.8±58.6um, p=0.02) and persisted over the 3 IFIs (p=0.01). PED height was reduced after the 3rd IFI (249.6±179.0 vs 206.9±130.0um, p=0.01). Mean VA (62.9 vs 62.7 approximate EDTRS letters, p=0.42) and interval between injections was similar after the 3rd IFI compared to baseline (6.3 vs 5.7 weeks, p=0.16). Eleven (8.7%) eyes were switched back to their previous anti-VEGF, including 2 (1.6%) eyes from 1 patient with intraocular inflammation requiring cessation of IFI. There were no other adverse events from switching. Switching to faricimab resulted in a reduction in mean CST (-11.6um, p=0.01) and PED height (-44.2um, p=0.01) after 3 injections with stable VA and at a similar treatment interval to prior anti-VEGF therapy.