Evaluation of Treatment Interval Extension and Short-Term Interval Stability after Switching to Faricimab in Neovascular AMD: A Mid-Term Observational Study.

Abstract

Introduction: The SHIFT-HB study (SwitcH Faricimab Treatment in High Burden patients) aimed to evaluate the anatomical and functional outcomes - and the short-term stability of extended dosing intervals - after switching to faricimab in high treatment burden (HB) neovascular age-related macular degeneration (nAMD) previously treated with first-generation anti-VEGF agents. The primary aim was to assess treatment interval changes after 6 intravitreal injections (IVIs) and the stability of interval gains between the 5th and 6th faricimab IVI.

Methods: Single-center, retrospective real-world study (November 2023-November 2024; tertiary center Edouard Herriot Hospital, Lyon). Eligible eyes had nAMD requiring ≤8-week intervals despite ≥6 prior aflibercept or ranibizumab injections. After the switch, all eyes received ≥6 faricimab IVIs under a proactive Treat-and-Extend regimen. Short-term stability was defined, among eyes with any interval gain, as a prescribed interval at V6 identical to or longer than that at realized at V5.

Results: In total, 190 eyes from 158 patients (mean age 81 ± 7.5 years; 57.9% female) were included. The mean pre-switch interval was 4.9 ± 1.2 weeks and increased to 6.7 weeks after 6 faricimab IVIs (p = 5.85 × 10-20). Interval increased in 61.6% of eyes; among these, 45% gained ≥3 weeks (range +3 to +8). Short-term stability between V5 and V6 occurred in 82.3% of responders. The maximum interval was first achieved at V6 in 52.1% of responder eyes. Among eyes with paired baseline and V6 measurements, best-corrected visual acuity remained stable (69.2 vs. 71.2 ETDRS letters; p = 0.67), while central retinal thickness decreased (303.1 µm-287.2 µm; p = 9.98 × 10-4). Intraocular inflammation occurred in 7 eyes (3.7%; 0.61% of injections) and led to drug discontinuation.

Conclusion: In real-world HB nAMD, switching to faricimab enabled a significant extension of injection intervals in nearly two-thirds of eyes while maintaining vision and improving OCT anatomy, supporting faricimab as a strategy to reduce treatment burden in this difficult-to-treat population.