改用法利昔单抗治疗耐药新生血管性年龄相关性黄斑变性的临床疗效：系统评价和荟萃分析

IF 4.2 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2025-08-21 DOI:10.1016/j.ajo.2025.08.034

CHARLES ZHANG , GEORGES ABOUKASM , DANIEL A LAI , NICHOLAS LEUNG , DANIEL ZHU , THOMAS A ALBINI , NICOLAS A YANNUZZI

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引用次数: 0

摘要

法利昔单抗治疗难治性新生血管性年龄相关性黄斑变性（nAMD）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Clinical Efficacy of Switching to Faricimab in Treatment Resistant Neovascular Age-Related Macular Degeneration: Systematic Review and Meta-analysis

Topic

Faricimab in the treatment of treatment-resistant neovascular age-related macular degeneration (nAMD).

Clinical Relevance

While many studies on faricimab in treatment-resistant eyes have reported improvements in retinal thickness (RT), the impact on visual acuity (VA) remains inconsistent. Additionally, variability in dosing protocols—with some studies utilizing loading interval for the first 3 injections while others continuing at the prior injection interval—introduces further uncertainty regarding the optimal treatment strategy. Understanding these differences is essential for guiding clinical decision-making and maximizing patient outcomes.

Methods

This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD420251000088). A systematic search of PubMed, Embase, and Scopus (February 3, 2025) identified studies evaluating the effects of switching to faricimab in treatment-resistant nAMD. Inclusion criteria required patients to have received ≥3 prior anti-VEGF injections and ≥3 faricimab injections, with reported outcomes on RT, VA, fluid status, or injection intervals. Outcomes were measured following completion of loading dose and at last follow up, ranging from 3 months to 1.5 years. Studies were assessed for bias using ROBINS-I and NIH Quality Assessment tool and assessed for certainty of evidence using GRADE. Meta-analyses were conducted using mean differences, odds ratio, and random-effects models.

Results

Fourteen studies (926 eyes) met inclusion criteria. Switching to faricimab significantly reduced RT by 46.67 µm (95% CI: 35.91-57.42, I² = 0%, 721 eyes). Eyes that followed a loading interval were found to have greater reduction in RT than those that did not (I² = 74.1%, 640 eyes). The odds of achieving a dry macula increased 4.35-fold (95% CI: 2.95-6.42, I² = 64%, 379 eyes). Eyes with baseline VA <65 ETDRS letters showed a gain of 3.16 letters (95% CI: 0.80-5.52, I² = 0%, 439 eyes). Injection intervals were extended by 1.56 weeks (95% CI: 0.71-2.40, I² = 86%, 591 eyes). Using GRADE, 4 outcomes were graded as either very low (VA, dryness, and treatment interval) or low (RT).

Conclusion

Switching to faricimab in treatment-resistant nAMD eyes significantly improved RT with no change in VA. This effect was greater with a loading interval protocol. Overall, there was an extension of injection intervals. Further prospective studies are needed to optimize dosing strategies and assess long-term efficacy.

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.