从阿柏西普转换为 faricimab 治疗抵抗性新生血管年龄相关性黄斑变性的结局。

Outcomes of Treatment-Resistant Neovascular Age-Related Macular Degeneration Switched from Aflibercept to Faricimab.

机构信息

Sunderland Eye Infirmary, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom.

Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; The Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.

出版信息

Ophthalmol Retina. 2024 Jun;8(6):537-544. doi: 10.1016/j.oret.2023.11.015. Epub 2023 Nov 29.

DOI:10.1016/j.oret.2023.11.015

PMID:38040055

Abstract

PURPOSE

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.

摘要

目的

尽管先前的研究已经证明了 faricimab 在治疗初发新生血管性年龄相关性黄斑变性（nAMD）患者中的疗效，但对于接受 aflibercept 玻璃体腔内注射（IVI）治疗效果不佳的患者转换为 faricimab 的临床解剖和功能结局了解较少。本研究旨在评估在因持续疗效不佳而从 aflibercept 转换为 faricimab 的 nAMD 患者中，转换为 faricimab 的临床解剖和功能结局。

设计

回顾性病例系列。

受试者

在单一三级护理中心接受 nAMD 治疗的患者，由于持续疗效不佳，从 aflibercept 转换为 faricimab。

方法

患者接受了至少 6 次连续的 aflibercept IVI，尽管在转换时以 4 周或 6 周的间隔接受 aflibercept，但 OCT 上仍持续存在视网膜内（IRF）或视网膜下液（SRF）。接受 4 周 aflibercept 的患者转换为 2 或 3 个 4 周 loading dose 的 faricimab 注射。回归模型用于确定临床结局的预测因素。

主要观察指标

视力、黄斑中心厚度（CMT）和 OCT 参数在转换前和转换后进行评估。

结果

纳入了 68 例 81 只眼的患者。平均年龄为 79.1 岁（标准差：8.9），女性占 53%。转换后 CMT 显著降低（P < 0.0001）。IRF（P = 0.0219）和 SRF（P < 0.000）的病例比例显著下降。80%的患者 OCT 上整体临床改善。未见 ETDRS 视力显著改善。没有证据表明转换方案（2 个 vs. 3 个 loading dose）对临床结局有独立影响。