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Real world experience with faricimab in switched neovascular AMD and evaluation of reloading versus interval matching
Ffion E Brown1, Madhuparna Mitra2
1Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK. Ffion.Brown@wales.nhs.uk.
Background:
A subset of eyes with neovascular AMD experience sub-optimal response to anti-VEGF therapy resulting in frequent injections. Faricimab has been used in this cohort due to reputed increased durability. Dosing strategies when switching vary, particularly regarding the need for a reloading phase. Our aim is to share our real-world experience of switching to faricimab with a clinician-directed dosing strategy.
Methods:
Retrospective analysis of eyes with neovascular AMD switched to faricimab from a previous anti-VEGF agent in Aneurin Bevan University Health Board, South Wales. Outcomes were evaluated at one year.
Results:
173 eyes from 134 patients were analysed. Mean visual acuity remained stable at one year (-0.1 letters). There was a statistically significant reduction in central subfield thickness of 30.0 μm (95% CI - 41.1 to -18.9; p < 0.001) and an increase in injection interval of 2 weeks (95% CI 1.5 to 2.4; p < 0.001). Within these parameters, the 'Reloaded' subgroup (n = 102) showed no clear advantage over the 'Not reloaded' (interval matched ± 2 weeks) subgroup (n = 71). The 'Reloaded' subgroup had received fewer prior injections and had shorter baseline injection intervals before switching.
Conclusions:
Switching to faricimab was associated with stable vision, reduced macular oedema and increased injection intervals at one year. A clinician-directed dosing strategy at switching yielded comparable outcomes between subgroups, suggesting a reloading phase may not be required for all eyes. This has potential benefits for reducing demand on service capacity.
