Switching to Faricimab for Polypoidal Choroidal Vasculopathy with Real-World Outcomes in Refractory Cases - The FAR-PEARL Study Report 1.

Purpose: To present real-world outcomes of switching to faricimab in eyes with polypoidal choroidal vasculopathy (PCV) refractory to previous anti-VEGF treatments. Methods: This retrospective study included PCV eyes switched to faricimab for recurrent PCV (>180 days from prior anti-VEGF treatment), suboptimal extension (60-180 days), or recalcitrant PCV (<60 days). Patients were followed monthly, with PRN reinjections for persistent subretinal fluid (SRF), intraretinal fluid (IRF), or pigment epithelial detachment (PED) at the fovea, or a 1-line vision drop. The primary outcome was time to injection-free status (no injection for 3 months), analyzed via survival analysis. Results: We included 49 eyes with PCV (mean age 66.1 ± 9.5 years; 59% women), 29% had recurrent PCV, 37% suboptimal extension, and 34% recalcitrant disease. Patients had a median of 8 prior anti-VEGF injections,the majority being aflibercept and received a median of 3 faricimab injections (Interquartile range (IQR)=2-4, range=1-8)) over 344 days (IQR=198-446). The interval between the first two faricimab injections averaged 64 ± 43 days, longer in recurrent (86 ± 55 days) vs recalcitrant PCV (43 ± 26 days, p=0.008). By day 90, 49% were injection-free, increasing to 73% by day 210. PED resolved in 53% after the first dose, and in those needing repeat injections, the interval peaked after the fourth dose with no SRF, IRF, nor PED. Conclusion: The differential response to faricimab in PCV depends on disease type, with recurrent cases requiring fewer injections and recalcitrant cases requiring more intensive initial treatment; however, even recalcitrant eyes can achieve extended intervals after initial doses.