Short-Term Outcomes of Faricimab Treatment in Aflibercept-Refractory Eyes with Neovascular Age-Related Macular Degeneration

Abstract

To evaluate the functional and anatomical effects of switching to faricimab for patients with neovascular age-related macular degeneration (nAMD) refractory to intravitreal aflibercept, this retrospective study evaluated patients with nAMD who received intravitreal injections of aflibercept (IVA) every <8 weeks and were switched to faricimab. After switching, the patients were treated with a treatment and extended regimen that started with the interval just before switching and received at least three injections. We evaluated changes in the best-corrected visual acuity (BCVA), central retinal thickness (CRT), central choroidal thickness (CCT), treatment interval, and presence of retinal fluid. Overall, 55 eyes from 55 patients were examined. After three injections of faricimab, the BCVA and CCT did not change significantly. However, the CRT decreased significantly (p < 0.05), the injection interval was significantly extended (7.5 ± 2.3 vs. 5.9 ± 1.5 weeks, p < 0.01), and the rates of the presence of intraretinal fluid and subretinal fluid decreased significantly to 16.4% and 40% of eyes, respectively (both p < 0.01). An ocular adverse event (retinal pigment epithelium tear) developed in one eye. Switching to faricimab was effective for anatomic changes. It may be an additional treatment option for some eyes refractory to IVA.

Factors Associated with Success of Switching to Faricimab for Neovascular Age-Related Macular Degeneration Refractory to Intravitreal Aflibercept

“…Similar reports in Japan have shown success rates of 29.1-40.8%. This is consistent with the prevalence of 32.6% reported in this study [17,18]. The finding that 30% of patients who are refractory to IVA can nearly double their treatment interval at six months is a great hope for patients who receive frequent conventional treatment.…”

“…This is the first report to identify the factors associated with the success of switching to faricimab for aflibercept-refractory type 1 MNV. Switching from aflibercept to faricimab for refractory nAMD results in improved visual outcomes and longer dosing intervals in many cases [17,18,[21][22][23]. However, the factors contributing to switch success have not been analyzed owing to the retrospective nature of the studies, short-term follow-up, and relatively small sample size of participants.…”

“…In a clinical trial of patients with nAMD, faricimab exhibited efficacy, longer dosing intervals, and safety that were not inferior to those of aflibercept [16]. In real-world studies with patients who were resistant to aflibercept, switching to faricimab extended the dosing interval from 5.9 to 7.5 weeks or from 4.4 to 8.7 weeks, with success rates ranging from 29.1% to 40.8% [17,18]. Thus, switching to faricimab is a promising option for refractory cases.…”

Short-term outcomes of treatment switch to faricimab in patients with aflibercept-resistant neovascular age-related macular degeneration

“…Some of the recent papers similarly to our study, report on results with neovascular AMD patients who were switched over to faricimab due to treatment resistance with previous anti-VEGF agents [15-18, 21, 23, 25, 27]. Most of these studies agree that switching over to faricimab proved to be an effective treatment for neovascular AMD for anatomic changes [15-17, 21, 23], with preserved [15,17,23] or improved visual outcomes [18,21], with longer [17,18,25,27] or similar treatment intervals [23] compared to prior anti-VEGF therapy, and is considered safe [16].…”

“…Following the pivotal TENAYA and LUCERNE trials [11] and the approval of faricimab in the USA [8] and the European Union [9], several authors reported on their initial experiences with the drug. A handful of real-world studies reported on short-term results [15][16][17][18][19][20][21][22][23][24], but due to the novelty of the drug, studies with 6-months of follow-up [25,26] or longer [27] are only available in a very limited number.…”