Real world experience with faricimab in switched neovascular AMD and evaluation of reloading versus interval matching regimes

Background A subset of eyes with neovascular AMD experience sub-optimal response to anti-VEGF therapy resulting in frequent injections. Faricimab has been used in this cohort due to reputed increased durability. Dosing strategies when switching vary, particularly regarding the need for a reloading phase. Our aim is to share our real-world experience of switching to faricimab with a clinician-directed dosing strategy. Methods Retrospective analysis of eyes with neovascular AMD switched to faricimab from a previous anti-VEGF agent in Aneurin Bevan University Health Board, South Wales. Outcomes were evaluated at one year. Results 173 eyes from 134 patients were analysed. Mean visual acuity remained stable at one year (–0.1 letters). There was a statistically significant reduction in central subfield thickness of 30.0 μm (95% CI − 41.1 to −18.9; p < 0.001) and an increase in injection interval of 2 weeks (95% CI 1.5 to 2.4; p < 0.001). Within these parameters, the ‘Reloaded’ subgroup ( n = 102) showed no clear advantage over the ‘Not reloaded’ (interval matched ± 2 weeks) subgroup ( n = 71). The ‘Reloaded’ subgroup had received fewer prior injections and had shorter baseline injection intervals before switching. Conclusions Switching to faricimab was associated with stable vision, reduced macular oedema and increased injection intervals at one year. A clinician-directed dosing strategy at switching yielded comparable outcomes between subgroups, suggesting a reloading phase may not be required for all eyes. This has potential benefits for reducing demand on service capacity.