Early anatomical rescue after switching to aflibercept 8 mg in faricimab-refractory neovascular AMD

To evaluate early anatomical outcomes after switching to aflibercept 8 mg in eyes with neovascular age-related macular degeneration (nAMD) refractory to faricimab.

This retrospective study included 32 eyes of 31 patients with nAMD who were switched from faricimab to aflibercept 8 mg due to persistent or recurrent fluid. Main outcome measures included central subfield thickness (CST), best-corrected visual acuity (BCVA), and proportion of eyes achieving fluid-free macula at weeks 8 and 16. Subgroup analyses were performed based on diagnosis (PCV vs non-PCV) and prior treatment history.

Mean CST decreased significantly from 374.0 ± 88.3 μm at the time of switch to 324.6 ± 80.6 μm at week 8 (p = 0.003) and 321.4 ± 84.0 μm at week 16 (p = 0.002). Fluid-free rate increased from 18.8 to 43.8% at week 8 and 46.9% at week 16. Mean BCVA remained stable throughout. Both PCV (n=12) and non-PCV (n=20) subgroups showed significant CST reduction. Eyes treatment-naïve before faricimab and those treatment-experienced before faricimab demonstrated comparable responses. No serious adverse events were observed.

Switching to aflibercept 8 mg resulted in rapid and significant anatomical improvement in faricimab-refractory nAMD, with most improvement occurring by week 8. The treatment was effective across diagnostic subtypes including PCV and regardless of prior treatment burden. Although early anatomical improvement was observed, the long-term durability of this response remains unknown and warrants further study.