The impact of swithching faricimab in the treatment of neovascular age-related macular degeneration: a real-world analysis

To report a real-world analysis of switching to faricimab in the setting of neovascular age-related macular degeneration (nAMD), with regards to fluid volumes on optical coherence tomography (OCT), treatment interval, and best corrected visual acuity (BCVA). We retrospectively collected the OCT scans of all eyes that were being treated with anti-vascular endothelial growth factor (VEGF) therapy and were switched to faricimab in clinical the practices of eight retina specialists at five clinics in three Australian states (CORRNet Study Group; Clinical Ophthalmologists’ Real-world Research Network). Only those that remained on faricimab are the subject of this report. All OCT scans were analyzed for both the presence and volume of intraretinal fluid (IRF) and subretinal fluid (SRF) using machine learning (ML) algorithms (Macuject Pty Ltd, Melbourne, Australia). Mean interval time between injections and BCVA were recorded at the time of switch and after the switch to faricimab. Of the 3082 eyes of 2200 patients treated with intravitreal anti-VEGF injections for nAMD, 473 eyes (84.0% of those switched to faricimab) remained on faricimab and thus met the criteria to be included in the analysis. At the time of switch to faricimab the number of eyes having IRF, either alone or in combination with SRF, was 142 (30.0%) and the number of eyes with SRF, either alone or in combination with IRF, was 223 (47.2%). Following the switch to faricimab, for the 142 eyes with any IRF, 115 eyes (80.9%) had a reduction in IRF volume, and of the 223 eyes with SRF, 190 eyes (85.2%) had a reduction in SRF volume, and 64 of the 69 (92.8%) eyes with both IRF and SRF present had a reduction in both fluid subtypes. The interval distribution shifted from a mean of 5.78 ± 1.92 (SD) to 6.91 ± 2.26 (SD) weeks over the study period (p < 0.001). The mean BCVA improved from 63.91 ± 20.03 logMar letters to 69.25 ± 17.38 logMar letters (p < 0.001) after the switch. Switching to faricimab in eyes with nAMD previously treated with other anti-VEGF agents was associated with anatomical and functional improvements in this selected cohort. Further prospective studies including the comparison with other anti-VEGF agents are warranted to more definitively evaluate the clinical benefits of faricimab in this setting.