Abstract
Purpose :
To examine functional and anatomic changes after switching to faricimab therapy in patients with longstanding neovascular age-related macular degeneration (nAMD).
Methods :
A retrospective chart review identified nAMD patients with three or more years of prior anti-VEGF treatment who switched to intravitreal faricimab from a single ophthalmology clinic in Sydney, Australia. Treatment history and visual acuity (VA) was obtained from medical records. Central subfield thickness (CST), intra-retinal fluid (IRF), sub-retinal fluid (SRF) and pigment epithelial detachment (PED) dimensions were measured from ocular coherence tomography scans. Changes in efficacy parameters were examined over the first three visits following switch.
Results :
Twenty-two eyes from 22 patients of mean age 78.4 ± 8.3 years were included in the study. Patients had received a mean of 66.4 ± 31.3 anti-VEGF injections over 90.7 ± 47.1 months, with 4.7 ± 1.6 injections received in the six months prior to switching. Fifteen (68%), eyes switched from aflibercept, 5 (23%) from brolucizumab and 2 (9%) from ranibizumab. Eleven eyes (50%) had previously switched from another anti-VEGF. At baseline, mean VA score was 65.8 ± 10.1 letters and mean CST was 376.7 ± 119.9 µm. PED was present in 95% of patients, of which 88% were classified as fibrovascular. After switching to faricimab, CST significantly reduced at visits 1, 2 and 3 (mean change = -38.6 ± 66.4 µm, -46.1 ± 72.5 µm and -56.6 ± 80.4 µm respectively, all p = 0.013). SRF max height significantly reduced at visit 1 and 2 (mean change = -57.9 ± 79.6 µm & -29.9 ± 30.9 µm respectively, both p = 0.014) but not at visit 3 (p = 0.169). PED height also reduced at visits 1 and 2 (mean change = 27.6 ± 48.1 µm & 22.8 ± 38.6 µm, p = 0.016 & 0.019 respectively) but not at visit 3 (p = 0.131). No changes were seen in IRF size or PED width (all p ≥ 0.05). Proportions of eyes with any retinal fluid (SRF/IRF) were 95.5%, 86.4% 73.7% and 68.8% at baseline, visit 1, visit 2 and visit 3 respectively. VA did not significantly change at any visit (all p ≥ 0.05). No ocular adverse events were identified.
Conclusions :
Eyes chronically treated for nAMD demonstrated reduced CST and maintenance of VA after switching to faricimab. Anatomic improvements from switching resulted from changes in SRF and PED, leading to complete fluid resolution over time in some patients.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.