Six-month outcomes of switching from aflibercept to faricimab in refractory cases of neovascular age-related macular degeneration

Graefes Arch Clin Exp Ophthalmol. 2024 Jan;262(1):43-51. doi: 10.1007/s00417-023-06222-x. Epub 2023 Sep 5.

Abstract

Purpose: To assess 6-month outcomes of switching from aflibercept to faricimab in eyes with refractory neovascular age-related macular degeneration (nAMD) previously requiring monthly injections.

Methods: This multicenter retrospective study examined nAMD eyes receiving monthly aflibercept injections switched to faricimab administered monthly up to 4 injections followed by injections at a minimum of 2-month intervals as per drug labeling. Data regarding age, sex, number of previous injections, treatment intervals, and best-corrected visual acuity (BCVA) were collected. Central retinal thickness (CRT), subfoveal choroidal thickness (SFCT), and maximal pigment epithelial detachment (PED) height were measured by optical coherence tomography.

Results: The study included 130 eyes of 124 patients. At 6 months, 53 eyes (40.8%) continued on faricimab treatment (Group 1), while 77 eyes (59.2%) discontinued faricimab for various reasons (Group 2) the most common being worse exudation. There were no significant differences between the two groups at baseline. In Group 1, CRT and SFCT significantly decreased at 1 month (P = 0.013 and 0.008), although statistical significance was lost at 6 months (P = 0.689 and 0.052). BCVA and maximal PED height showed no significant changes; however, mean treatment intervals were extended from 4.4 ± 0.5 weeks at baseline to 8.7 ± 1.7 weeks at 6 months (P < 0.001) in Group 1. No clear predictors of response were identified.

Conclusion: Switching from aflibercept to faricimab allowed for extension of treatment intervals from monthly to bimonthly in roughly 40% of eyes, suggesting that faricimab may be considered in refractory nAMD cases.

Keywords: Aflibercept; Angiopoietin-2; Faricimab; Neovascular age-related macular degeneration; Vascular endothelial growth factor.

Publication types

  • Multicenter Study

MeSH terms

  • Angiogenesis Inhibitors / therapeutic use
  • Antibodies, Bispecific*
  • Follow-Up Studies
  • Humans
  • Intravitreal Injections
  • Macular Degeneration* / diagnosis
  • Macular Degeneration* / drug therapy
  • Receptors, Vascular Endothelial Growth Factor / therapeutic use
  • Recombinant Fusion Proteins / therapeutic use
  • Retinal Detachment* / drug therapy
  • Retrospective Studies
  • Tomography, Optical Coherence / methods
  • Treatment Outcome
  • Wet Macular Degeneration* / diagnosis
  • Wet Macular Degeneration* / drug therapy

Substances

  • aflibercept
  • faricimab
  • Receptors, Vascular Endothelial Growth Factor
  • Recombinant Fusion Proteins
  • Angiogenesis Inhibitors
  • Antibodies, Bispecific