Comparison of morphological and functional parameters after switching therapy from brolucizumab to faricimab in neovascular age-related macular degeneration

Abstract Background Brolucizumab, an anti-vascular endothelial growth factor (VEGF) agent, offers extended dosing intervals in neovascular age-related macular degeneration (nAMD) but carries a rare risk of retinal vasculitis. Faricimab, a bispecific antibody targeting VEGF and angiopoietin-2 (Ang-2), maintained efficacy with dosing intervals of up to 16 weeks in the TENAYA and LUCERNE trials and carries a lower reported inflammatory risk. Patients may therefore be switched from brolucizumab to faricimab. This study examines the morphological and functional response after such a switch. Methods Patients with nAMD were included in this retrospective case series. Eligibility required at least three consecutive brolucizumab injections before switching to faricimab. The primary outcome was the change in central retinal thickness (CRT); secondary outcomes were the change in best-corrected visual acuity (VA) and adverse events. Results The study included 31 eyes from 28 patients treated with brolucizumab and switched to faricimab. Mean visual acuity (VA) was 0.3 logMAR (Snellen equivalent ~20/40) at visit -3, with no significant change after three brolucizumab injections (0.3 logMAR, ~20/40, p=0.932). After switching to faricimab, mean VA was 0.332 logMAR (~20/40) with no statistically significant difference from the value after three brolucizumab injections (p=0.187). Central retinal thickness (CRT) remained stable before (355.00µm to 347.29µm, p=0.538) and after switching (366.54µm, p=0.190). Of the 11 eyes that were free of fluid before the switch, 10 did not remain dry, and CRT increased significantly (282.9µm to 367.9µm, p=0.013) after extending intervals on average by +2.3 weeks (min 0 to max +5 weeks). However, visual function remained stable (p=0.559). In contrast, two eyes became dry with shorter intervals (-2 weeks), one eye remained dry (+2 weeks) and 18 eyes remained active (-0.5 weeks). Conclusions Overall, morphological and functional parameters remained stable after switching to faricimab, and the safety profile was stable. Because every eye received both agents sequentially and no concurrent brolucizumab control group was included, this was not a head-to-head comparison. The increase in retinal thickness in some cases highlights the need for individualized treatment based on patient response.