Durability of Three Monthly Loading Doses with Faricimab in Treatment-Naïve Neovascular Age-Related Macular Degeneration

INTRODUCTION: Understanding the durability of faricimab with three monthly loading injections in a real-world clinical setting is important for optimizing treatment intervals and reducing the treatment burden. The aim of this study was to evaluate the durability and visual outcomes of a loading dose regimen consisting of three consecutive monthly faricimab injections in treatment-naïve patients with neovascular age-related macular degeneration (nAMD). METHODS: This is a retrospective, single-center cohort study using chart review and an electronic injection database, including treatment-naïve patients with nAMD aged 50 years or older who received three monthly faricimab injections between 1 November 2023 and 31 August 2024. RESULTS: Overall, 827 eyes of 742 patients were included in the study. Following the loading dose, the median injection-free interval was 15.0 weeks (95% confidence interval [CI] 13.1 to 16.6). The estimated injection-free survival probabilities at 4, 6, 8, 10, 12, 14, 16, and 24 weeks were 90.9%, 81.1%, 79.1%, 75.5%, 57.1%, 51.1%, 48.6%, and 29.4%, respectively. At 180 days, 28.4% (n = 235) of eyes remained injection-free, and 21.6% (n = 179) were discharged from hospital-based care. At 4 weeks post-loading, 42.6% of eyes showed improved best-corrected visual acuity (BCVA), 46.3% were stable, and 11.1% declined. The mean BCVA change was -0.082 logarithm of the minimum angle of resolution (logMAR) (95% CI -0.097 to -0.067; p < 0.001), corresponding to a gain of approximately 4 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters. CONCLUSIONS: A three-injection loading dose regimen of faricimab demonstrated favorable durability, with most eyes maintaining a long injection-free interval and experiencing visual improvement or stability. A routine follow-up at 4 weeks after loading may be unnecessary in many patients, whereas 8 weeks appear adequate. Treatment after loading can be paused for an extended period in a substantial subset of patients. Faricimab may reduce treatment burden early, while providing stabilization or improvement of visual acuity for the majority of patients with nAMD in clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov registration no. NCT06890026; date of registration: 16 March 2025 (retrospectively registered).