Faricimab in Treatment-Resistant Neovascular AMD: First Real-world Experience in Lithuania

PURPOSE To assess the first real-world outcomes of faricimab in previously treated eyes of treatment-resistant neovascular age-related macular degeneration (nAMD) patients in a tertiary university hospital in Lithuania. SETTING / VENUE Department of Ophthalmology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics. METHODS A retrospective review of all patients treated with faricimab for nAMD from September 2023 to February 2024 was performed. All of the patients were previously treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections (IVTI) and treatment-resistant. The data collected: background demographics, treatment history regarding the type of anti-VEGF agent, number of IVTI, treatment intervals, best corrected visual acuity (BCVA) in decimal, central subfield thickness (CST) in microns (µ), sub/intra retinal fluid (SRF/IRF) and adverse events. RESULTS 25 eyes (20 patients) were included with mean of 2.52±1.19 faricimab IVTI. Mean age was 77.08±10.67 years (min. 55, max.91), 17 were women (58.6%) and 8 men (27.6%). Patients received in total a mean of 30.6±17.44 anti-VEGF IVTI every 8.68±1.22 weeks (min. 6.18, max.11.57) prior to switching to faricimab. In 2022 the mean number of IVTI was 5.50±1.64, in 2021 – 5.36±1.33. Most were treated with either aflibercept and bevacizumab combination (34.5%) or ranibizumab and bevacizumab combination (37.9%). The mean BCVA did not significantly improve from 0.35±0.34 before switching to faricimab to 0.37±0.29 4 weeks after the first faricimab IVTI (p>0.05). After one IVTI of faricimab all eyed demonstrated reduction in CST with the mean CST significantly decreasing from 317.54±89.24 µ to 265.76±48.39 µ in 4 weeks (p=0.001). Prior to switching to faricimab 8 eyes (33.33%) had IRF, 9 eyes (37.50%) SRF, 5 eyes (20.84%) both IRF and SRF and 2 eyes were dry (8.33%) (n=24). After the first faricimab IVTI after 4 weeks a complete dryness was observed in 8 eyes (40%), IRF in 5 eyes (25%), SRF in 6 eyes (30%), both IRF and SRF in 1 eye (5%) (n=20) respectively. No intraocular inflammation cases were registered. CONCLUSIONS Real-world first experience of faricimab IVTI in Lithuania demonstrated significant reduction in CST even in treatment-resistant nAMD patients. More patients were completely dry after 4 weeks of the switching to faricimab which may in future reduce the number of visits, prolong treatment intervals, and maintain dry macula. Larger number of patients and longer follow-up period are needed for further evaluation, but the need of possibility to switch the patients for better anatomical and possibly visual outcomes is vital in the future disease management of nAMD in Lithuania.