Abstract
Purpose :
Recent studies demonstrate that the novel bispecific antibody faricimab, which blocks both VEGF-A and Ang-2 in neovascular AMD (nAMD), is effective at improving BVCA, DRSS, and reducing CST. This pilot study aims to quantify faricimab’s ability to stabilize intraretinal fluid (IRF) and subretinal fluid (SRF) and correlate between types of fluid drying and vision recovery in patients with nAMD after switching from an anti-VEGF.
Methods :
This is a retrospective chart review of patients with nAMD, switched from intravitreal anti-VEGF to faricimab. BVCA and OCT images were compiled before and after switch. Age, anti-VEGF history, and injection frequency were tabulated. 10 eyes from 9 patients who met the criteria were identified: 5 eyes showed IRF, and 5 eyes showed SRF. 7 eyes were switched to faricimab from aflibercept, 1 from brolucizumab, 1 from avastin, and 1 from ranibizumab. With MATLAB 2022a, OCT scans taken prior to switch, on day of switch, and upon three injections following switch, were analyzed. For each eye, steady-state total fluid area (TFA) is the average fluid area in the OCT taken the day of switch and one previous injection. Total SRF or IRF area throughout the scan was used as a proxy for total retinal fluid accumulation. BCVA was converted to Snellen logMAR estimation.
Results :
The average age of the 9 patients was 82 +/- 10 years, with an average VEGF history of 1446 +/- 896 days (Figure 1). The IRF+SRF group (n=10) had an average TFA of 38 +/- 44% (p<0.005) at 8-weeks and 41 +/- 48.1% (p<0.005) at 16-weeks (Figure 2a). The SRF group (n=5) showed significant reduction in TFA at 8 and 16-weeks (Figure 2b, c). The IRF group showed significant letter recovery from 54 +/- 14 letters at steady state to 63 +/- 12 letters (p < 0.05) at 16-weeks after switch (Figure 3). The SRF group had no significant change in letter recovery. There was no significant change in CST following switch. The IRF+SRF group had a significant reduction in percent PED height from steady state to 8-weeks 75 +/- 22% (p<0.01), and 16-weeks 82 +/- 25% (p<0.05) after switch (Figure 4).
Conclusions :
We show quantitative evidence that faricimab stabilizes IRF and SRF in nAMD patients switched from anti-VEGF agents. The SRF and IRF+SRF groups demonstrated significant fluid reduction with improvement in BCVA in the IRF group. There was significant reduction in PED height in the IRF+SRF group after switch.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.