Quantitative analysis of real-world reduction in intraretinal and subretinal fluid compartments following switch of anti-VEGF agent to faricimab in the treatment of neovascular age-related macular degeneration

Abstract

Purpose : To measure volumetric changes in macular fluid compartments following switching of anti- vascular endothelial growth factor (VEGF) therapy for neovascular AMD (nAMD) to faricimab.

Methods : We retrospectively collected the optical coherence tomography (OCT) scans of all eyes that had their nAMD anti-VEGF agent switched to faricimab by eight retina specialists for the first nine months of 2023. All scans acquired in routine clinical practice from six months before switch and subsequently at every clinic visit were analysed using a machine learning algorithm to measure volumes of intraretinal (IRF) and subretinal fluid (SRF). The mean volume of each fluid compartment at time of switch was calculated as a baseline. The proportion of eyes that had a reduction of each fluid compartment was calculated for the whole cohort. Of those eyes with any fluid compartment present before the switch, the absolute volume reductions, when they occurred, were then calculated for the eyes treated by each participating 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. At the time of switch, 307 eyes (63.3%) had fluid present on OCT. Of these eyes, 175 (57%) had any reduction in fluid, including IRF for 64 eyes and SRF for 111; 31 eyes (8%) had a reduction in both IRF and SRF. When considering only the eyes that had a reduction in fluid volume, the mean reduction in volume was greater for IRF (61nL, SE = 4.76) than SRF (22nL, SE = 10.75).

Conclusions : Switching anti-VEGF agent to faricimab in the treatment of nAMD is associated with a reduction of SRF in a greater proportion of eyes than for a reduction in IRF. However, the reduction in volume itself is nearly three times greater for IRF.

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