Functional and Anatomical Outcomes of Faricimab in Previously Treated Wet Age-Related Macular Degeneration: Systematic Review and Pooled Analysis.

INTRODUCTION

To evaluate the outcomes of intravitreal faricimab (IVF; Vabysmo) in previously treated patients with wet age-related macular degeneration (wAMD), focusing on best available visual acuity (BAVA), central subfield thickness (CST), injection interval, complications, fluid resolution, and reversion rates to prior therapies.

METHODS

The PubMed, Embase, and Google Scholar databases were searched for studies reporting outcomes of treatments for previously treated cases of wAMD. Mean differences (MD) with 95% confidence intervals (CI) were used to compute the effect size of the change in outcomes.

RESULTS

A total of 29 studies with 2070 patients (1003 women, mean age 78.9 years) and 2128 eyes were included. BAVA and CST were reported in 28 studies, fluid status in 21, injection interval in 14, and reversion rates in 6. Pooled analysis showed significant but modest improvement in BAVA when IVF was given for > 6 months (MD = -0.026 LogMAR, p < 0.05) but not at earlier follow-ups. A similar trend was noted with injection interval extension when IVF was given beyond 6 months (MD = +2.1 weeks, p < 0.05). CST reduction was observed at all time points (overall MD = -37.7 μm, p < 0.05). Complication rates were reported in nine studies, with an overall rate of 1.2%, including retinal pigment epithelium tear, intraocular inflammation, endophthalmitis, and subretinal hemorrhage. Reversion to prior or other anti-vascular endothelial growth factor (anti-VEGF) therapy was reported in six studies, occurring in 23% of eyes.

CONCLUSIONS

We reported the outcomes of utilizing IVF in previously treated cases of wAMD. IVF showed a significant improvement in CST at all time points and in the extension of injection interval. Visual outcomes remained unchanged when followed for less than 6 months but improved significantly but modestly when followed for more than 6 months. Switching to intravitreal faricimab may be a useful treatment option for previously treated patients with wAMD, with a goal of reducing treatment burden and improving treatment efficacy.