Two-year real-world effectiveness of faricimab after treatment switch in neovascular age-related macular degeneration

PURPOSE: To evaluate the 2-year real-world outcomes of switching to intravitreal faricimab in patients with neovascular age-related macular degeneration (nAMD) previously treated with anti-VEGF agents and unable to extend treatment intervals (TI) beyond 12 weeks. METHODS: Prospective cohort study including patients with nAMD managed under a treat-and-extend regimen who required frequent anti-VEGF injections (< 12-week intervals) to maintain retinal dryness. Patients were switched to faricimab without a loading phase and followed for a minimum of 2 years. TI were extended in 4-week increments based on anatomical response. The primary outcome was change in TIl; secondary outcomes included change in best-corrected visual acuity (BCVA) and identification of predictors of response. "Optimal responders" were defined as eyes achieving ≥ 8-week interval extension. RESULTS: A total of 110 eyes from 97 patients were included (mean age 78.7 ± 9.8 years). Prior to switching, the mean TI was 6.18 ± 2.05 weeks, which increased significantly to 13.61 ± 5.62 weeks at the last follow-up visit (p < 0.001). BCVA remained stable over 2 years (0.42 ± 0.24 vs. 0.43 ± 0.25; p = 0.0117). At final follow-up, 68.2% of eyes achieved intervals ≥ 12 weeks, 20.0% ≥16 weeks, and 24.6% reached ≥ 20-week intervals. Overall, 89.1% of eyes experienced interval extension. Optimal responders accounted for 47.3% of eyes and were significantly younger and had received fewer prior injections (p < 0.05). CONCLUSIONS: Switching to faricimab in previous treated nAMD patients enabled meaningful extension of TI over 2 years while maintaining stable visual acuity. These findings support faricimab as an effective strategy to reduce treatment burden in patients who are difficult to extend with prior anti-VEGF therapies.