One-Year Outcomes of Faricimab Treatment for Aflibercept-Resistant Neovascular Age-Related Macular Degeneration

Abstract

Purpose

To assess the 12-month outcomes of intravitreal faricimab (IVF) in treatment-resistant neovascular age-related macular degeneration (nAMD) subjects recalcitrant to intravitreal aflibercept (IVA).

Methods

This study was conducted as a retrospective interventional case series of nAMD patients receiving treatment at a single private practice institution. All included patients at baseline had undergone six or more IVA injections over the previous 12 months, four or more IVA injections over the previous 6 months, had a central macular thickness (CMT) ≥320 µm on optical coherence tomography (OCT), and were observed to have intraretinal and/or subretinal fluid on OCT assessment. The baseline exam for the purpose of this study was considered the visit in which the patient was switched from IVA to IVF. Patients were managed with a real-world treat-and-extend protocol and followed over a 12-month study period.

Results

A total of 54 eyes of 54 subjects were analyzed. Overall, 31.5% (17/54) of subjects attained a treatment interval ≥8 weeks and had a fluid-free macula on OCT at 12 months. The CMT on OCT decreased from 395.4 (383.5–407.3) µm at baseline to 350.0 (335.1–364.8) µm at the end of the 12-month study interval (p<0.01). There were 16.7% (9/54) of subjects who gained three or more lines of Snellen visual acuity at the end of the study. Visual acuity improved from 0.72 (0.67–0.77) logMAR (Snellen 20/105) at baseline to 0.59 (0.55–0.64) logMAR (Snellen 20/78) at the end of the study (p<0.01).

Conclusion

A clinically significant minority of aflibercept-resistant nAMD subjects may attain longer treatment intervals and improved outcomes at 12 months after switching to IVF when a treat-and-extend treatment protocol is utilized. IVF use may be considered whenever resistance to IVA is encountered in this patient population.

Keywords:

• faricimab
• treatment-resistant
• neovascular age-related macular degeneration
• recalcitrance

Abbreviations

nAMD, neovascular age-related macular degeneration; CMT, central macular thickness; OCT, optical coherence tomography; VA, visual acuity.

Data Sharing

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics

The study was approved by the Panhandle Eye Group Institutional Review Board (IORG0009239; IRB00011013-12) in accordance with the ethical standards laid down in the Declaration of Helsinki. Informed consent from study participants was waived because this was a retrospective study with no identifying patient information presented.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

There is no funding to report.