Real world outcomes of faricimab in treatment resistant neovascular age-related macular degeneration among Asian patients.

To describe the real-world efficacy and safety outcome measurements of faricimab use in treatment-resistant neovascular age-related macular degeneration (nAMD) in a cohort of Asian patients. A tertiary hospital in central Singapore serving a resident population of approximately 1.5 million. Retrospective chart review of patients with nAMD previously treated using intravitreal bevacizumab, ranibizumab or aflibercept and were switched to faricimab between August 2022 to August 2023. Patients were switched to faricimab due to either the ineffectiveness of prior anti-VEGF agents to achieve retinal dryness or inadequate treatment intervals. Only patients who had at least one follow-up visit after switching to faricimab were included in the analysis. Primary outcome measures included best-corrected visual acuity (BCVA) in ETDRS letter score and Optical Coherence Tomography (OCT) measurements including central subfield thickness (CST), presence or absence of intraretinal fluid (IRF), subretinal fluid (SRF), intraretinal cysts and subretinal hyperreflective material (SRHM). Secondary outcome measures included adverse events and treatment history such as the mean number of injections and treatment intervals. One hundred and nineteen eyes (117 patients) with a mean age of 75.6 (58-93 years) were switched to faricimab and included in the analysis. Of these, 55 (47.0%) were males. The mean number of intravitreal anti-VEGF injections received was 28.2 ± 19.5 prior to switching to faricimab. The majority of these were switched from ranibizumab (26.1%) and aflibercept (73.1%). At baseline, BCVA was 62.7 ± 19.9 letter and mean CST on OCT was 352.5 μm ± 128.5 μm. Only 11 (9.2%) eyes were dry on OCT at baseline: 39.5% had presence of IRF, 72.3% had presence of SRF, 41.2% had presence of intraretinal cysts, and 50.4% had presence of SRHM. After switching to faricimab, the eyes received a mean of 4.8 ± 2.7 faricimab injections up to the time of data cut-off. At last visit, the mean BCVA maintained at 60.3 ± 20.7 letter and mean CST reduction was - 41.6 μm (p < 0.001). Compared to baseline, 49 (41.2%) were dry on OCT: 24.4% had presence of IRF, 41.2% had presence of SRF, 29.4% had presence of intraretinal cysts, and 48.7% had presence of SRHM (all p < 0.001). No serious ocular adverse events were reported. Switching patients with nAMD to faricimab in real-world scenarios has demonstrated the ability to maintain vision while adding anatomical gains in those previously resistant to alternative anti-VEGF therapy. Faricimab is well-tolerated with no serious ocular adverse events reported.