Short-Term Outcomes of Faricimab in Patients with Neovascular Age-Related Macular Degeneration on Prior Anti-VEGF Therapy

Purpose: A subset of patients with neovascular age-related macular degeneration (nAMD) experience treatment burden and suboptimal response with anti-VEGF therapy. The aim of this study was to investigate the effect of switching to a novel, bispecific agent, faricimab, in patients with nAMD currently treated with anti-VEGF. Design: Retrospective, noncomparative cohort study. Subjects: Patients with nAMD previously treated with anti-VEGF and switched to intravitreal faricimab injection (IFI) at the Cleveland Clinic's Cole Eye Institute. Methods: Switching and administration schedule of IFI was at the discretion of the clinician. Visual acuity (VA) and macular OCT parameters, including central subfield thickness (CST), maximum pigment epithelial detachment (PED) height, and presence of subretinal (SRF) or intraretinal fluid (IRF), were assessed at baseline (day of first IFI) and after each IFI. Main Outcome Measures: Central subfield thickness and presence of IRF or SRF after >= 3 IFIs. Results: One hundred twenty-six eyes of 106 patients were included in the analysis with a mean follow-up time of 24.3 +/- 5.2 weeks. Before switching to IFI, patients received a mean of either aflibercept (20.0 +/- 8.4, mean +/- standard deviation), bevacizumab (7 +/- 8.9), ranibizumab (1.9 +/- 8.5), or brolucizumab (0.3 +/- 1.6) injections. The most common agent used before switching to IFI was aflibercept (n = 110, 87%), and the mean treatment interval with any anti-VEGF was 5.6 +/- 1.6 weeks before switching. Central subfield thickness was reduced from baseline after the first IFI (266.8 +/- 64.7 vs. 249.8 +/- 58.6 mm, P = 0.02) and persisted over the 3 IFIs (P = 0.01). Pigment epithelial detachment height was reduced after the third IFI (249.6 +/- 179.0 vs. 206.9 +/- 130.0 mm, P = 0.01). The mean VA (62.9 vs. 62.7 approximate ETDRS letters, P = 0.42) and interval between injections (6.3 vs. 5.7 weeks, P = 0.16) was similar after the third IFI compared with baseline. Eleven (8.7%) eyes were switched back to their previous anti-VEGF, including 2 (1.6%) eyes from 1 patient with intraocular inflammation requiring cessation of IFI. There were no other adverse events from switching. Conclusions: Switching to faricimab resulted in a reduction in mean CST (-11.6 mm, P = 0.01) and PED height (-44.2 mm, P = 0.01) after 3 injections, with stable VA and at a similar treatment interval to prior anti-VEGF therapy.