Swapping Aflibercept for Faricimab May Benefit Patients With Nonresponsive Wet AMD

According to a small case study in England, patients with neovascular AMD (nAMD) who showed persistent suboptimal responses to aflibercept largely experienced improvement after being switched to faricimab, suggesting that faricimab may be an option for managing patients with treatment-resistant nAMD.

Study Design

A retrospective case series investigated whether switching patients with nAMD from aflibercept to faricimab resulted in demonstrable improvement in visual acuity and OCT parameters. All patients in the study (n = 68) showed resistance to aflibercept treatment, defined as having persistent intraretinal or subretinal fluid on OCT despite receiving a minimum of 6 consecutive aflibercept intravitreal injections at 4- to 6-week intervals. After the switch, patients were given either 2 or 3 injections of faricimab every 4 weeks as a loading dose to explore whether the dosing regimen influenced the observed response.

Outcomes

Eighty-one eyes from 68 patients were included in this study. After switching to faricimab, there was a statistically significant reduction in central macular thickness, intraretinal fluid, and subretinal fluid, with an overall improvement in OCT in 80% of patients. Even though there was a trend towards visual stability, there was no statistically significant improvement in mean ETDRS (Early Treatment Diabetic Retinopathy Study) vision. Additionally, there were no significant differences seen between using 2 or 3 injections as a loading dose.

Limitations

Limitations include that this was a retrospective study. There was also a small sample size, which may have been underpowered to detect changes in visual acuity.

Clinical Significance

Given the potential for clinical improvement, I will consider switching to faricimab for my patients with nAMD who are nonresponsive to aflibercept treatment.

Financial Disclosures: Dr. Marianeli Rodriguez discloses no financial relationships.