Predictive factors for injection interval extension after switching to faricimab in neovascular <scp>AMD</scp> : The <scp>FAR WEST</scp> multicentre study

PURPOSE: To assess whether switching to faricimab allowed extending injection intervals after 12 months (M12) in patients with neovascular age-related macular degeneration (nAMD) and to identify predictive factors for interval extension. DESIGN: FAR WEST was a multicentre, observational, retrospective cohort study. PARTICIPANTS: Patients with nAMD treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections for at least 1 year before switching to faricimab. METHODS: The reason for switching (clinician's intent to extend the interval in the absence or presence of a recurrence or refractory status), and the switch strategy (whether an induction phase comprising 2, 3 or 4 injections was performed using the same or a shorter interval, or whether the interval was immediately extended from the second injection without induction) were left to the physician's discretion. MAIN OUTCOME MEASURES: The following data were collected from the medical records at the time of the decision to switch to faricimab (M0) and at the M12 follow-up visit: recurrence-free interval, last injection interval, best-corrected visual acuity (BCVA), central macular thickness (CMT), exudation status and intraocular inflammation events. RESULTS: A total of 845 eyes of 718 patients were included in 23 centres. The recurrence-free injection interval increased significantly from 5.7 weeks at M0 to 8.6 weeks at M12 (difference: +2.9 weeks, p < 0.001). The proportion of exudative patients decreased from 571 (68%) to 337 (42%) (- 41%, p < 0.001). BCVA decreased from 0.33 (20/40) to 0.35 logMAR (20/40) (p = 0.0038). Among 238 refractory cases at M0, 84 (35%) achieved a dry macula at M12. In multivariable analysis, absence of an induction phase was associated with greater injection interval gain. (p < 0.001). There were no differences according to time since the first injection, type of neovascularization. The number of injections per year decreased from 8.7 at M0 to 6.1 at M12 (-2.6, p < 0.001), and the number of consultations decreased from 6.1 at M0 to 5.2 at M12 (-0.9, p < 0.001). The intraocular inflammation rate was 1.6% (n = 14). CONCLUSION: Switching to faricimab allowed significantly extending the recurrence-free injection interval, decreasing the proportion of exudative patients and reducing the therapeutic burden in nAMD patients. Further studies are needed to determine the most appropriate switching modalities and which patients actually require an induction phase.