Baseline Biomarkers Associated with Early Anatomical Response After Faricimab Loading Therapy in Treatment-Naïve Neovascular Age-Related Macular Degeneration

Background/Objectives: We identified baseline factors associated with early anatomical response to faricimab. Methods: This single-center retrospective study included 78 treatment-naïve eyes with neovascular age-related macular degeneration (nAMD) receiving three monthly faricimab injections. Eyes with complete resolution of intraretinal and subretinal fluid on optical coherence tomography (OCT) at 16 weeks constituted the fluid-free group, and the remaining eyes were assigned to the persistent-fluid group. Baseline OCT features (including subretinal hyperreflective material [SHRM], pigment epithelial detachment [PED] subtypes, and central retinal and choroidal thickness) and clinical characteristics were compared, and ARMS2 (rs10490924) and CFH (rs800292) were genotyped as an exploratory analysis. Multivariable logistic regression identified associated factors. Results: Fifty-five eyes (70.5%) achieved complete fluid resolution. In multivariable analysis, SHRM was independently associated with a favorable early anatomical response, and fibrovascular PED with incomplete early fluid resolution (p = 0.019 and p = 0.026); in an exploratory model, the ARMS2 risk allele was associated with incomplete fluid resolution (p = 0.008), whereas CFH was not. Conclusions: In treatment-naïve nAMD, baseline SHRM was associated with a favorable early anatomical response to faricimab, whereas fibrovascular PED and a higher ARMS2 T-allele count were associated with incomplete early fluid resolution. These characteristic OCT and genetic features may help identify eyes at risk of an incomplete early response.