Early real-world fluid-free treatment interval extension following switch to faricimab in the treatment of neovascular age-related macular degeneration with a treat and extend regimen - the first 9 months

Abstract

Purpose : To determine whether switching anti-vascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (nAMD) to faricimab is associated with an extended fluid-free interval (FFI) when following a treat and extend regimen.

Methods : The optical coherence tomography (OCT) scans of all eyes that had nAMD therapy switched to faricimab (from January 1st 2023 to September 30th 2023) were collected from patients treated by 8 retina specialists in 5 Australian clinics, following a treat and extend regimen.

The OCT scans were analysed using a machine learning algorithm to measure volumes of intraretinal (IRF) and subretinal fluid (SRF). For each fluid subtype, and the combination of both when present, the FFI of interest was defined as the greatest treatment interval (in weeks) at which there was no IRF, SRF, or both, detected. The longest FFI before the switch was subtracted from the longest after. The change in FFI was calculated both in aggregate for all eyes of all treating doctors and separately for each treating doctor.

Results : 2685 eyes of 1934 patients were treated with either aflibercept or ranibizumab during this period. 640 eyes were treated with faricimab at least once, of which 485 were switched from another agent. OCT scans were available for all injection visits for all eyes. There was a mean increase in longest FFI of 2.05 weeks (SE = 0.29, n=115) for IRF, 1.15 weeks (SE = 1.04, n=74) for SRF, and 2.42 weeks (SE = 0.41, n=53) for the combination of both.

The real-world experience of interval extension varied significantly between doctors, ranging from -0.67 to + 4.11 weeks for IRF, -2.5 to +2.67 weeks for SRF, and +1.67 to +3.5 weeks for the combination of IRF and SRF in the same eye.

Conclusions : Within the short period of the first nine months of faricimab’s availability in Australia, many of the eyes switched to faricimab appeared to benefit from extension of their fluid-free interval in this real-world study. An extension of this study in a larger cohort is warranted, to determine whether this effect is sustained, increased, or lost over time.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Figure 1. Difference between the max FFI before and after the switch to faricimab aggregate results

 

Figure 2. Difference between the max FFI before and after the switch to faricimab individual results