Faricimab for highly resistant CNV in wet age-related macular degeneration- 7 months observations using artificial intelligence

Abstract

Purpose : To analyze the therapeutic response to faricimab 6 mg in eyes that were diagnosed with refractory intra- and/ or subretinal fluid due to CNV previously unresponsive to 4 mg monthly aflibercept and/or simultaneous use of anti-VEGF and long-acting steroids. We hypothesized that these CNVs might respond to Faricimab due to its dual mechanism of action (anti-VEGF and anti-ANG-2).

Methods : Retrospective analysis of 25 consecutive eyes (88 injections) with unresponsive CNV to treatment escalation consisting of increasing doses of Anti-VEGF or combination anti-VEGF and Steroid injections (mean injection number prior to faricimbab (mean:35.52). All eyes had persistent intra- and/ or subretinal fluid in Optical Coherence Tomography (OCT). 6 mg faricimab was injected every 4 weeks. Best corrected visual acuity (BCVA), and OCT (Heidelberg Spectralis) central retinal thickness (CRT) were recorded every 4 weeks for 7 consecutive months. Volume of IRF, SRF, PED, and CRT for each visit using RetinAI software (Bern, Switzerland) based on OCT volume scans.

Results : A.I. retinal volume analysis showed a significant reduction of subretinal fluid after 1-month (from 77±206nL to 19±43nLwhich remained (from 77±206nL to 19.8±54nL, p=0.0479) at month two and stabilized over the next 6 months of treatment. There was a non-significant improvement in BCVA (max 2-3 ETDRS letters after 6-months). No eyes required glaucoma surgery or showed vascular occlusions, There was one case of recurrent anterior uveitis requiring change in anti-VEGF medication.

Conclusions : In highly resistant CNV due to AMD, an initial injection with Faricimab 6 mg, produced clear anatomic improvement which persisted with treatment for at least 7 months with a trend towards vision improvement . Faricimab may help treat resistant Wet-AMD when all other therapeutic options have been exhausted. Earlier use may benefit these eyes as well.

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