Real-world outcomes after switching to faricimab in previously treated neovascular age-related macular degeneration: longitudinal outcomes up to 24 months.

Abstract

Background: In neovascular age-related macular degeneration (nAMD), persistent disease activity despite anti-VEGF therapy is common. Switching to faricimab may improve outcomes and extend treatment intervals in treatment-resistant patients, but long-term real-world data remain limited.

Methods: In this retrospective, single-centre study, 43 eyes of 38 patients with treatment-resistant nAMD were switched to faricimab and followed for up to 24 months. Insufficient disease control was defined as inability to extend treatment intervals beyond 8 weeks under a treat-and-extend regimen. Outcomes included best-corrected visual acuity (BCVA), central subfield thickness (CST), pigment epithelial detachment (PED) height, fluid status, and treatment intervals. Longitudinal changes were analysed using mixed-effects models. Exploratory analyses of baseline and early response predictors were performed.

Results: Mean BCVA remained stable throughout follow-up, with no significant change from baseline at any time point (p > 0.05). CST decreased significantly at all visits, ranging from - 45.8 μm (95% CI - 65.3 μm to - 26.3 μm) at 1 month to - 52.3 μm (95% CI - 73.7 μm to - 30.8 μm) at 24 months (p < 0.001). PED height decreased at 1 month (- 19.0 μm; 95% CI - 33.6 μm to - 4.4 μm, p = 0.011) and remained reduced from 12 to 24 months, ranging from - 25.9 μm (95% CI - 39.7 μm to - 12.1 μm, p < 0.001) to - 49.1 μm (95% CI - 65.1 μm to - 33.0 μm, p < 0.001). Presence of subretinal fluid decreased significantly at all time points, with odds ratios (OR) ranging from 0.064 (95% CI 0.01 to 0.41, p = 0.004) at 1 month to 0.012 (95% CI 0.01 to 0.10, p < 0.001) at 24 months, whereas intraretinal fluid showed a variable response, with a significant reduction observed at 3 months only (OR 0.204, 95% CI 0.05 to 0.79, p = 0.021). The proportion of eyes with a dry macula increased from 0% at baseline to 23.1% at 12 months and 24.0% at 24 months. Treatment intervals extended from 5.9 ± 1.2 weeks before switch to 8.7 ± 2.6 weeks at 12 months (p < 0.001) and 10.6 ± 3.0 weeks at 24 months (p < 0.001). No adverse events were observed.

Conclusion: Switching to faricimab was associated with improved anatomical outcomes and extended treatment intervals while maintaining stable visual acuity, suggesting benefits primarily related to anatomical control and reduced treatment burden.