Switching to Faricimab Effective for Treatment-Resistant Wet AMD

Credit: Victor Freitas/Unsplash

A switch from aflibercept to faricimab demonstrated positive outcomes among patients with treatment-resistant neovascular age-related macular degeneration (nAMD), according to a recent retrospective care series study.¹

Across patients with nAMD at a single tertiary care center, switching was linked to significant anatomical improvement, with a trend toward visual stability, and the loading regimen for faricimab appeared sufficient for non-naive patients.

“Among patients with treatment-resistant nAMD, switching from aflibercept to faricimab may serve as a safe and effective option,” wrote the investigative team, led by Raffaele Raimondi, MD, Sunderland Eye Infirmary, South Tyneside and Sunderland NHS Foundation Trust.

Anti-vascular endothelial growth factor (VEGF) agents serve as the standard of care to slow vision loss for patients with retinal diseases, particularly nAMD.² Previous research has confirmed the efficacy of faricimab for treatment-naive patients with nAMD—on the other hand, outcomes for those switched from aflibercept to faricimab are less described.³

In the current study, Raimondi and colleagues sought to evaluate the clinical and functional outcomes of a switch to faricimab in patients receiving intravitreal aflibercept injections for nAMD with a suboptimal response. The retrospective case series included patients with nAMD at a single center switched from aflibercept to faricimab after experiencing persistent suboptimal response.

These patients had received a minimum of 6 consecutive intravitreal aflibercept injections and showed intraretinal (IRF) or subretinal fluid (SRF) on optical coherence tomography (OCT), despite receiving injections at 4 or 6-weekly intervals before the switch.

Those receiving 4-weekly aflibercept were switched with 2 or 3 loading doses of 4–weekly intravitreal faricimab injections. Regression models helped investigators identify predictors of clinical outcomes.

The main outcomes for the case series analysis included visual acuity, central macular thickness (CMT), and OCT parameters assessed at the pre-switching and post-switching periods. A total of 81 eyes of 68 patients were included for analysis. Patients had a mean age of 79.1 years and the majority (53%) of cases were female.

Upon analysis, Raimondi and colleagues identified a statistically significant reduction in CMT in the post-switching period (P <.0001). Meanwhile, the number of cases with IRF (P = .0219) and SRF (P <.000) experienced significant decreases.

Overall clinical improvement on OCT was identified in approximately 80% of patients, but investigators found no significant improvement in Early Treatment Diabetic Retinopathy Study (ETDRS) letters. Investigators also noted no evidence that the switching regimen, involving 2 versus 3 loading doses, demonstrated an independent effect on clinical outcomes.

Overall, these data suggested the switch from aflibercept to fairicmab could provide a tolerable and effective treatment option for the population with treatment-resistant nAMD, but more research is needed to assert these findings.

“However, a longer follow-up and larger studies are warranted to confirm these findings,” Raimondi and colleagues wrote.

References

1. _{Raimondi R, Falfeli T, Bogdanova-Bennet A, et al. Outcomes of Treatment-Resistant Neovascular Age-Related Macular Degeneration Switched from Aflibercept to Faricimab. Ophthalmol Retina. 2024;8(6):537-544. doi:10.1016/j.oret.2023.11.015}
2. _{Yiu G, Gulati S, Higgins V, et al. Factors Involved in Anti-VEGF Treatment Decisions for Neovascular Age-Related Macular Degeneration: Insights from Real-World Clinical Practice. Clin Ophthalmol. 2024;18:1679-1690. Published 2024 Jun 6. doi:10.2147/OPTH.S461846}
3. _{Quah NQX, Javed KMAA, Arbi L, Hanumunthadu D. Real-World Outcomes of Faricimab Treatment for Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema. Clin Ophthalmol. 2024;18:1479-1490. Published 2024 May 27. doi:10.2147/OPTH.S463624}