Additional Effects of Faricimab in Aflibercept Low-Responders: Retinal Morphology and Function in Eyes with Neovascular Age Related Macular Degeneration Following a Switch Between Two Anti-VEGF Agents.

Purpose: To assess how transitioning from an Aflibercept to a Faricimab intravitreal treatment impacts retinal structures and functional aspects in patients with neovascular age related macular degeneration (nAMD) in a real-life setting.

Patients and methods: A retrospective clinical study including 49 patients (57 eyes) with nAMD at the Department of Ophthalmology and Optometry, Kepler University Hospital, Linz, Austria was performed. The patients, who had previously been receiving monthly Aflibercept injections with an unsatisfactory treatment response, were switched to intravitreal Faricimab and followed-up between 12/2022 and 12/2023.

Results: The mean treatment-interval before the fifth injection with Faricimab was 5.35 ± 1.49 weeks and was therefore significantly longer compared to the monthly interval with Aflibercept (p < 0.001). Mean baseline central retinal thickness (CRT) was 267.82 ± 76.00 µm and decreased significantly already at month 1 to 249.61 ± 65.35 µm (p < 0.001). After the fourth intravitreal injection, there was no significant change with a CRT of 252.95 ± 56.96 µm (p = 0.134). There was a significant reduction in the number of patients showing subretinal fluid (SRF) and intraretinal fluid (IRF). In eyes with fibrovascular pigment epithelium detachment (PED), an interval extension was not possible in more than half of the cases. Eyes with serous and drusenoid PED and a rather high amount of hyper-reflective foci (HRF), the majority showed a significant response after the switch.

Conclusion: An initial loading dose could be beneficial to elongate Faricimab's additional effect of reducing retinal swelling in eyes with nAMD and previous low-response to Aflibercept. Serous and drusenoid PEDs seem to benefit more than fibrovascular PEDs. A high amount of intraretinal HRF in patients with PED was a sign for good respondence to Faricimab.