Faricimab in neovascular AMD: first report of real-world outcomes in an independent retina clinic

Abstract

Purpose: Assess short-term real-world outcomes in neovascular aged-related macular degeneration (nAMD) treated with novel faricimab.

Methods: Retrospective case series of nine patients with nAMD (11 eyes) treated with faricimab between May and November 2022. Treatment-naïve patients and non-naïve patients underwent logMAR best corrected visual acuity (BCVA), optical coherence tomography (OCT) DRI OCT-1 Triton (Topcon Corp, Tokyo, Japan), ultra-widefield (UWF) and fundus autofluorescence (FAF) (California Optomap, Optos plc, Dunfermline, Scotland, UK). Previous treatment intervals, number of intravitreal injections, sub/intra retinal fluid (SRF/IRF), central retinal thickness (CRT) and presence/changes in pigment epithelial detachments (PEDs) were recorded.

Results: Mean baseline BCVA and CRT values of patients who switched from other agents were 0.612 ± 0.75 logMAR and 256.16 ± 12.98 µm respectively, with a mean 36-day previous treatment interval. The median number of other previous anti-VEGF intravitreal injections was 8. Mean BCVA at one month significantly improved to 0.387 ± 0.54 logMAR, as well as CRT values which decreased to 245.43 ± 15.34 µm. In the 3 naïve patients, mean baseline BVCA and CRT values were 0.33 ± 0.29 and 874.67 ± 510.86 µm, respectively. At one month follow-up, mean BCVA improved to 0.30 ± 0.29 logMAR and mean CRT was 536.04 ± 36.15 µm. Overall, a significant improvement in BCVA of 0.21 ± 41 logMAR and 238.44 ± 114.9 µm was achieved at one month after the first faricimab intravitreal injection. In addition, a complete resolution of SRF was observed in 6 out of 8 eyes (75%) and of IRF in 2 out of 3 eyes (66.67%), respectively. Drusenoid PED morphology changes were observed in all patients and no drug-related adverse events were observed.

Conclusion: Real-world outcomes showed improvement in BCVA and anatomic parameters at an early timepoint, demonstrating the efficacy and durability of faricimab in nAMD patients. Larger numbers of patients and longer follow-up are needed to determine whether the loading dose is required in all, what percentage of patients experience an improvement, and whether improvement it is maintained.

Fig. 1. Resolution of SRF and PED flattening after the initial intravitreal injection of faricimab.

Case 5: A complete response to the treatment that lasted 10 weeks was observed in a 76-year-old male, who used to have Eylea™ intravitreal injections every 4 to 6 weeks. SRF resolution (red arrows) and PED flattening (yellow arrows) after the 1^st faricimab is shown in A and B. Case 6: UWF RG (C) and FAF (D) scans demonstrated retinal pigment epithelium abnormalities in the fellow eye. An occult or type 1 CNV was observed on the UWF FFA (E). Below, comparative maps of macular topography and OCT images before faricimab injection (F) and 24-week follow-up after the first and only faricimab dose (G) shows resolution of SRF (red arrows) and modification of morphology and height of dPED (yellow arrows).

Fig. 2. Varying responses in different eyes to faricimab in the same patient.

A, B (Case 7) The resolution of minimal SRF (red arrows) and reduction of dPED (yellow arrows) in a 76-year-old female with nAMD after the faricimab injections (B). However, a course of four faricimab intravitreal injections was needed. C, D Demonstrate SRF (red arrows) and IRF (yellow asterisks) resolution in the fellow eye (Case 8) at one month after the first faricimab injection.

Fig. 3. Resolution of multiple PEDs after the first faricimab intravitreal injection.

Case 9: Patient diagnosed with nAMD using multimodal and simultaneous imaging including UWF RG (A), FAF (B), FFA (C) and ICGA (D) with navigated SS-OCT. In E and F, a resolution of multiple PEDs was observed after the first injection of faricimab (blue arrows).

Fig. 4. Efficacy of faricimab in the resolution of subretinal and subRPE haemorrhages.

Case 10: UWF RG images showed a progressive resolution of subretinal and subRPE haemorrhage in a nAMD patient, who was treated twice in one-monthly intervals with faricimab (A) at baseline, (B) at one month, (C) at two months. A significant and progressive reduction of the haemorrhage (green arrows) is also observed in SS-OCT after the faricimab loading phase (4 injections) treatment in spite of minimal SRF appearance (red asterisk) (D). Case 11: Large fibrovascular PED in a nAMD patient. The haemorrhage appears to be subretinal and sub-RPE in UWF RG, FFA and ICGA images (E, F, G). However, SS-OCT scans demonstrated a large PED with associated subretinal haemorrhage (blue arrow) and subretinal fluid (SRF) (red arrow), ruling out sub-RPE haemorrhage (H).