Pigment epithelial detachment as a biomarker for faricimab treatment outcomes in naïve neovascular age-related macular degeneration

ObjectiveTo assess baseline pigment epithelial detachment (PED) and other OCT biomarkers for predicting response to faricimab in treatment-naïve patients with neovascular age-related macular degeneration (nAMD).DesignThis was an observational, retrospective, single-arm, monocentric cohort study.Subjects and methodsFifty-seven eyes of 51 patients with naive nAMD-associated PED and treated with faricimab were included in the study. Best-corrected visual acuity (BCVA) and OCT were performed at baseline, monthly until Month 4, and at Months 6, 9, and 12. Fluid volume dynamics and other OCT biomarkers were quantified using an AI-based tool.ResultsAt Month 12, mean BCVA increased by 4 letters (<i>P</i> < 0.01), mean CRT decreased by 66.2 µm (<i>P</i> < 0.0001), and mean maximum PED height decreased by 70.4 µm (<i>P</i> < 0.001). AI-based PED dynamics showed rapid and sustained reductions from 488.2 nL at baseline to 166.6 nL at Month 12 (<i>P</i> < 0.0001), with more profound reductions in serous versus fibrous PED volume. All AI-quantified OCT biomarkers were significantly (<i>P</i> < 0.0001) changed from baseline after the loading phase. OCT biomarkers, PED, and fluid dynamics during the loading phase were correlated with functional and anatomic outcomes at Month 4 and Month 12.ConclusionsFaricimab had a rapid, profound and sustained drying effect on the retinas of eyes with nAMD and PED, with marked reductions in OCT biomarkers after loading and sustained to Month 12. These improvements coincided with significant improvements in BCVA. PED height, type, and volume at baseline correlated with short- and long-term treatment outcomes.