Efficacy of switching treatment to faricimab in recalcitrant neovascular age related macular degeneration - 6 month results after completion of the loading phase.

Purpose: To report the efficacy and durability of switching treatment to faricimab in recalcitrant neovascular age-related macular degeneration (nAMD) at six months after completion of the loading phase (nine months after switching).

Methods: Recalcitrant nAMD was defined as persistent fluid despite monthly injections (q4w) or inability to extend treatment intervals beyond six weeks (q6w). The study included patients on a treat & extend regimen for six months after three monthly injections. Primary outcomes were changes in central subfield thickness (CST), subfoveal choroidal thickness (SFCT), visual acuity, and injection interval.

Results: Nine month-data was available for 56 eyes initially switched to faricimab. At nine months, 51 eyes (91.1%) of 49 patients were maintained on faricimab, while five eyes (8.9%) had been switched back to their older agent. At nine months after switching, median CST was significantly reduced as compared to baseline at switching (332,00 (Q1:295,00; Q3:394,00) to 303,00 (Q1:269,00; Q3:366,00) µm; p < 0.001). Median SFCT also decreased from 158,00 (Q1:116,00; Q3:219,00) µm to 127,00 (Q1:95,00; Q3:196,00) µm (p < 0.001). The average injection interval was significantly extended from 37.0 ± 9.5 days prior to switching to 56.1 ± 30.4 days at nine months (p = 0.002). Visual acuity was maintained (0.30 (Q1:0.10 Q3:0.50) vs. 0.30 (Q1:0.10 Q3:0.50) logMAR; p = 0.07).

Conclusion: In recalcitrant nAMD, faricimab can improve CST and SFCT while maintaining visual acuity. Furthermore, greater durability could be achieved with faricimab at nine months as compared to ranibizumab or aflibercept. Further prospective randomized trials are warranted.