Switching to Faricimab for Polypoidal Choroidal Vasculopathy with Real-World Outcomes in Refractory Cases - The...

To present real-world outcomes of switching to faricimab in eyes with polypoidal choroidal vasculopathy (PCV) refractory to previous anti-VEGF treatments.

This retrospective study included PCV eyes switched to faricimab for recurrent PCV (>180 days from prior anti-VEGF treatment), suboptimal extension (60-180 days), or recalcitrant PCV (<60 days). Patients were followed monthly, with PRN reinjections for persistent subretinal fluid (SRF), intraretinal fluid (IRF), or pigment epithelial detachment (PED) at the fovea, or a 1-line vision drop. The primary outcome was time to injection-free status (no injection for 3 months), analyzed via survival analysis.

We included 49 eyes with PCV (mean age 66.1 ± 9.5 years; 59% women), 29% had recurrent PCV, 37% suboptimal extension, and 34% recalcitrant disease. Patients had a median of 8 prior anti-VEGF injections,the majority being aflibercept and received a median of 3 faricimab injections (Interquartile range (IQR)=2-4, range=1-8)) over 344 days (IQR=198-446). The interval between the first two faricimab injections averaged 64 ± 43 days, longer in recurrent (86 ± 55 days) vs recalcitrant PCV (43 ± 26 days, p=0.008). By day 90, 49% were injection-free, increasing to 73% by day 210. PED resolved in 53% after the first dose, and in those needing repeat injections, the interval peaked after the fourth dose with no SRF, IRF, nor PED.

The differential response to faricimab in PCV depends on disease type, with recurrent cases requiring fewer injections and recalcitrant cases requiring more intensive initial treatment; however, even recalcitrant eyes can achieve extended intervals after initial doses.