Intravitreal Faricimab Associated With Increased Treatment Interval, Decreased CST

Increased mean treatment interval and decreased central subfield thickness (CST) were associated with patients with previously treated neovascular age-related macular degeneration (nAMD) using intravitreal faricimab, according to a study published in Clinical Ophthalmology.¹ However, mean best corrected visual acuity (BCVA) showed no signs of improvement when patients used faricimab.

AMD is the most common cause of blindness in the world. Treatment for AMD often consists of anti–vascular endothelial growth factor (anti-VEGF) injections, particularly in nAMD. Faricimab was approved by the FDA for use against nAMD in 2022,² and it is often used in patients who are treatment naïve. However, it's efficacy has not been evaluated in those who are treatment experienced. This study aimed to assess the visual and anatomic outcomes of faricimab in patients who had previously used anti-VEGF medication.

Faricimab can help to increase treatment interval times and decrease CST in patients with nAMD. | Image credit: RFBSIP - stock.adobe.com

Patients were enrolled in this study who received care through the Department of Ophthalmology and Vision Science at University of California Davis Health for nAMD and who had received faricimab between August 2020 and November 2023. Patients were eligible if they were diagnosed with nAMD, had initiated faricimab, exhibited intraretinal or subretinal fluid on an optical coherence tomography (OCT) after 6 months of treatment, and had been treated in the past with an anti-VEGF treatment. If a patient had another diagnosis that required treatment through anti-VEGF, they were excluded.

Eyes with at least 1 follow-up visit were the only eyes included in the study for outcome measurements. All participants had their demographic data collected prior to the study, including age, sex, and history of retinal conditions. Reasoning for switching treatments was also included for all participants.

There were 88 eyes from 73 patients included in the study overall. Aflibercept, brolucizumab, bevacizumab, and ranibizumab were the most common anti-VEGF treatments.

The mean (SD) logMAR BCVA of the patients was 0.5 (0.3) at baseline, prior to the initiation of faricimab; the mean injection interval was 6.06 (2.0) weeks. The mean baseline CST was 291 (73) μm as assessed by an OCT. Subretinal fluid (SRF) was found in 43.2% of patients, intraretinal fluid (IRF) was found in 27.3%, both types were found in 14.8%, and no fluids were found in 14.8% of patients as they started faricimab.

The mean follow-up was 30.1 (13.5) weeks, with a mean injection number of 5.1 (2.4). The mean logMAR BCVA was 0.5 (0.4) at the last visit, with no significant change. However, mean injection interval increased to 7.44 (2.6) weeks and CST decreased to 262 (63) μm. SRF was found in 28.4% of eyes, IRF was found in 25.0% of eyes, both types were found in 6.8%, and no fluid was found in 39.8% eyes after treatment. Complete resolution of IRF/SRF was found in 36% of patients who had fluid at baseline.

Treatment for 26% of the eyes was discontinued due to poor response, joining a clinical trial, insurance barriers, loss to follow-up, and 1 death. Further, treatment was stopped for 9.1% of the eyes due to adverse events, including eye irritation, persistent floaters, and new subjective vision loss.

There were some limitations to this study. There was a limited sample size of eyes included in the final cohort, and the study had a retrospective design, which could make it subject to selection bias. In addition, all participating retinal specialists used the treat-and-extend regimen but it could vary slightly based on the physician. Only 14.8% of the eyes had no IRF or SRF even though all eyes had IRF or SRF within 6 months of starting faricimab.

“Faricimab demonstrates improved anatomical outcomes in patients with nAMD while decreasing the frequency of injections,” the authors concluded. Eyes with nAMD that have been refractory to multiple therapies may have diminished benefits from the use of this therapy.

References

1. Hang A, Ngo T, Virk JS, et al. Intravitreal faricimab for previously treated neovascular age-related macular degeneration. Clin Ophthalmol. 2024;18:3781-3789. doi:10.2147/opth.s494605

2. Joszt L. FDA approves faricimab to treat wet AMD and DME. AJMC^®. January 31, 2022. Accessed December 20, 2024. https://www.ajmc.com/view/fda-approves-fariximab-to-treat-wet-amd-and-dme