Clinical Outcomes of Faricimab in Patients with Previously Treated Neovascular Age-Related Macular Degeneration

Purpose: To assess the anatomic and functional outcomes in eyes with neovascular age -related macular degeneration (nAMD) previously treated with anti-VEGF therapy in response to intravitreal faricimab. Design: Retrospective, interventional, consecutive case series. Subjects: Patients with previously treated nAMD who received > 4 consecutive injections of faricimab were included. The study period was from March through November 2022. Methods: Clinical and imaging data were extracted from the electronic medical record. Central foveal thickness (CFT), maximum fibrovascular pigment epithelial detachment (fvPED) height, and Snellen visual acuity (VA) were obtained. Generalized estimating equations were used to analyze the change in CFT, maximum fvPED height, and logarithm of the minimum angle of resolution VA. Main Outcome Measures: Change in CFT, maximum fvPED height, and Snellen VA before faricimab and after > 4 faricimab intravitreal injections. Results: During the study period, 218 eyes of 191 patients met inclusion criteria. Mean age was 79.9 (range, 70.6-89.2) years. The mean number of intravitreal anti-VEGF injections received before faricimab was 34.2 (range, 6.4-62). The following results were found after > 4 faricimab injections. Mean logarithm of the minimum angle of resolution VA before switching to faricimab was 0.58 (Snellen VA w20/76; range, 20/22-20/264) and was 0.55 (Snellen VA w20/71; range, 20/21-20/235; P = 0.20) after switching. Mean maximum fvPED height was 195.0 (range, 50.2-339.8) mm before switching to faricimab and improved to 165.0 (range, 33.6-296.4; P < 0.001) mm after switching. Mean CFT was 354.8 (range, 184.7-524.9) mm before switching to faricimab and improved to 306.6 (range, 144.4-468.8; P < 0.001) after switching. The proportion of eyes with intraretinal fluid was 36.7% (80/218 eyes) before switching, and decreased to 24.8% (54/218 eyes, P < 0.001) after switching. The proportion of eyes with subretinal fluid was 53.2% (116/218 eyes) before switching and decreased to 26.6% (58/ 218 eyes, P < 0.001) after switching. Conclusions: Intravitreal faricimab may improve anatomic outcomes in patients with previously treated nAMD, while maintaining VA in the short-term.