Abstract
Purpose :
Faricimab, one of the newer anti-vascular endothelial growth factor (anti-VEGF) intravitreal agents, targets two different pathways involved in the pathogenesis of neovascular age-related macular degeneration (nARMD). Of note, faricimab may benefit eyes with a history of prior treatments for nARMD, which is critical since a significant minority of eyes do not respond adequately to the first anti-VEGF agent selected. This retrospective observational study aimed to examine both the early and late responses to faricimab treatment in a subset of particularly treatment-experienced nARMD eyes that had received at least two different anti-VEGF agents prior to starting faricimab injections.
Methods :
A retrospective chart review was conducted on patients with nARMD who had received at least two different anti-VEGF agents prior to faricimab. Basic demographic information and intravitreal injection history were gathered for each patient. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) macular imaging parameters were collected at each patient’s baseline visit, initial post-injection visit, and most recent clinical visit with OCT following last faricimab injection. Wilcoxon signed-rank test was used to compare BCVA and central subfield thickness (CST) at each follow-up to baseline values.
Results :
23 eyes were included. Average total number of anti-VEGF injections before first faricimab injection was 51±32. The mean time elapsed between first faricimab and initial follow-up was 6.7±4.1 weeks, and the mean time between initial injection and final follow-up was 39.5±10.4 weeks. Average logMAR BCVA was 0.5±0.6 at baseline, 0.5±0.5 at initial follow-up (p=0.12), and 0.6±0.7 at final follow-up (p=0.50). Average CST was 302±86 μm at baseline, 274±80 μm at initial follow-up (p<0.001), and 270±91 μm at last follow-up (p<0.001). 3 eyes (13.0%) had neither subretinal nor intraretinal fluid at baseline. 12 eyes (52.2%) had neither subretinal nor intraretinal fluid at both initial follow-up and final follow-up.
Conclusions :
In a small subset of patients with treatment-experienced nARMD, faricimab resulted in a mild decrease in CST and fluid resolution in several eyes but had minimal effect on BCVA. These findings may be partly secondary to irreversible retinal atrophy in this patient population, but more research is needed with larger sample sizes to help determine the efficacy of faricimab in this setting.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.