Abstract
Purpose :
Faricimab, a novel therapy for neovascular age-related macular degeneration (nAMD), inhibits both vascular endothelial growth factor (VEGF) and angiopoietin. It may be more effective than therapies targeting VEGF alone. To test this hypothesis, we report our real-world experience using intravitreal faricimab in nAMD eyes previously treated with other anti-VEGF therapy.
Methods :
Single-center retrospective chart review (August 2022-August 2023) of patients receiving faricimab for nAMD for persistent macular fluid on other anti-VEGF drugs, excluding eyes with prior vitreoretinal surgery or other concurrent retinal condition. Clinical and demographic data including best corrected visual acuity (BCVA), number and type of anti-VEGF injection, and macular optical coherence tomography (OCT) with central subfield thickness (CST) were collected. Statistical analyses utilized t-tests and multiple linear regression.
Results :
We identified 88 eyes (73 patients) meeting study criteria. The average age was 82±1 (range 57-101). The average number and duration of prior anti-VEGF injections were 27.5 injections (range 1-127) and 41.9 months (range 1-169), respectively. Mean baseline VA was 20/63 (range 20/20 to CF) with mean anti-VEGF injection interval of 6.1±0.2 weeks (range 4-15). Mean baseline CST was 292±7.8 µm. During mean follow-up of 30.9±1.5 weeks (range 7-60) after starting faricimab, the eyes received a mean of 5.1±0.26 injections (range 1-11). Mean BCVA remained at 20/63 (p=0.11), but mean injection interval increased to 7.4 weeks (p<0.001), and mean CST decreased to 261±6.7 µm (p<0.001). Multiple linear regression analysis revealed that the total number of anti-VEGF injections at baseline was not significantly associated with CST change on faricimab (p=0.57) but a higher number of different anti-VEGF drugs used at baseline was associated with a lower decrease in CST on faricimab (p=0.055). Faricimab was discontinued in 25 eyes (21 patients) (28%) for reasons including poor response (32%) and subjective vision loss (32%).
Conclusions :
In nAMD eyes previously treated with other anti-VEGF, intravitreal faricimab use was associated with increased mean treatment interval and decreased CST but no improvement in mean BCVA. The benefit of faricimab on CST may be diminished in eyes previously treated with multiple different types of anti-VEGF therapy.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.