Switching to the intravitreal administration of faricimab in patients with aflibercept-refractory neovascular age-related macular degeneration: the three-year results with the “treat and extend, then fix” regimen

Abstract Purpose To clarify the efficacy of switching to intravitreal faricimab injection (IVF) in patients with aflibercept-refractory neovascular age-related macular degeneration (nAMD) over a three-year follow-up. Methods We retrospectively reviewed 31 consecutive eyes of 30 Japanese patients (median age, 75 years) with nAMD who switched from aflibercept to faricimab using a “treat and extend, then fix” regimen. Results Twenty-eight eyes of 27 Japanese patients (19 men, 8 women) were included in this study. The median visual acuity (VA) was stable at month 36. The median central retinal thickness and subfoveal choroidal thickness significantly decreased from 234 μm to 202 μm at baseline to 142 μm and 151 μm at 36 months ( p < 0.0001, p < 0.0001, respectively). Twenty-two eyes (78.6%) achieved a dry macula at month 36 and had improved VA levels with an improvement of 0.52 lines, which was significantly different from the remaining 6 eyes, (0.58: p < 0.01, decline of 1.90 lines: p < 0.05). Over a 36-month period, the median number of faricimab injections was 13, and the median treatment interval was 12 weeks. A progression of macular atrophy or newly developing macular atrophy was seen in 7 eyes (25%) with a decline of 2.06 lines at month 36. No other complications were observed. Conclusions Switching to IVF maintained stable VA and provided favorable anatomical improvements over 36 months in patients with aflibercept-refractory nAMD. The visual outcomes remained stable, and the achievement of a dry macula at 36 months was significantly associated with VA levels and changes at 36 months.