Intravitreal Faricimab improves visual and anatomic outcomes for Aflibercept-Resistant nAMD

There were a total of 55 subjects analyzed. There were 39.3% (11/28) in the Study Group and 7.4% (2/27) in the Control Group attaining a CMT of less than 300 microns without retinal fluid on OCT at the end of the 4-month study period (p = 0.004). There were 35.7% (10/28) in the Study Group and 7.4% (2/27) in the Control Group gaining 2 or more lines of visual acuity at the end of the 4-month study period (p = 0.008).

Both visual and anatomic outcomes were improved in a clinically significant minority when subjects were switched to faricimab from aflibercept in cases of recalcitrant nAMD. This suggested that faricimab potentially offers fewer intravitreal injections without compromising long-term outcomes in this difficult-to-treat subgroup of treatment-resistant nAMD subjects when a treat-and-extend protocol is employed, as is the preference for a majority of vitreoretinal specialists. The authors considered this benefit clinically meaningful since 27.6–70.3% of subjects undergoing anti-VEGF therapy for nAMD have been reported to persist with intraretinal and/or subretinal fluid on OCT despite monthly injections and studies suggest that long-term visual outcomes are optimal when all residual retinal fluid is resolved. Fewer intravitreal injections with stable visual and anatomic outcomes in this elderly population may benefit the patient (fewer doctor visits), the specialist (more opportunity to see other vitreoretinal patients requiring attention), and society (lower overall cost to the payer).

In conclusion, switching nAMD subjects who are recalcitrant to aflibercept treatment to faricimab may result in better visual and anatomical outcomes in a statistically significant portion of subjects, thereby leading to potentially longer treatment intervals when a real-world treat-and-extend management protocol is followed. Further research is warranted to confirm these findings, especially with a longer follow up period.

Source: Rush and Rush; Clinical Ophthalmology 2022:16 https://doi.org/10.2147/OPTH.S395279