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Lookup NU author(s): Maged Habib, Professor David SteelORCiD
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© 2023 American Academy of OphthalmologyPurpose: Although previous studies have demonstrated the efficacy of faricimab in treatment-naive patients with neovascular age-related macular degeneration (nAMD), its outcomes in patients switched from aflibercept are less understood. This study aimed to assess clinical anatomical and functional outcomes of switching to faricimab in patients undergoing aflibercept intravitreal injections (IVIs) for nAMD with suboptimal response. Design: Retrospective case series. Subjects: Patients with nAMD at a single tertiary care center who were switched from aflibercept to faricimab due to persistent suboptimal response. Methods: Patients had received a minimum of 6 consecutive IVIs of aflibercept and showed persistent presence of intraretinal (IRF) or subretinal fluid (SRF) on OCT despite receiving aflibercept at 4 or 6-weekly intervals at the time of the switch. Patients receiving 4-weekly aflibercept were switched with either 2 or 3 loading doses of 4-weekly faricimab injections. Regression models were used to identify predictors of clinical outcomes. Main Outcome Measures: Visual acuity, central macular thickness (CMT), and OCT parameters were assessed preswitch and postswitch. Results: Eighty-one eyes of 68 patients were included. The mean age was 79.1 years (standard deviation: 8.9), and females constituted 53% of cases. A statistically significant reduction in CMT was observed postswitch (P < 0.0001). The proportion of cases with IRF (P = 0.0219) and SRF (P < 0.000) decreased significantly. Overall clinical improvement on OCT was noted in 80% of patients. No significant improvement in ETDRS vision was observed. There was no evidence that switching regimen (2 vs. 3 loading doses) had an independent effect on clinical outcomes. Conclusion: Among patients with treatment-resistant nAMD, switching from aflibercept to faricimab may serve as a safe and effective option. Significant anatomical improvements were observed, with a trend toward visual stability. The loading regimen with 2 faricimab injections appeared to be sufficient for nonnaive patients. However, a longer follow-up and larger studies are warranted to confirm these findings. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Author(s): Raimondi R, Falfeli T, Bogdanova-Bennet A, Varma D, Habib M, Kotagiri A, Steel DH, Grinton M
Publication type: Article
Publication status: Published
Journal: Ophthalmology Retina
Year: 2024
Pages: epub ahead of print
Online publication date: 29/11/2023
Acceptance date: 22/11/2023
ISSN (print): 2468-6530
Publisher: Elsevier Inc.
URL: https://doi.org/10.1016/j.oret.2023.11.015
DOI: 10.1016/j.oret.2023.11.015
PubMed id: 38040055
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