Faricimab in previously treated nAMD: Real-World Outcomes of a No-Loading-Dose Switching Protocol.

INTRODUCTION: Evaluate efficacy, anatomical outcomes, and safety of switching to faricimab without a loading dose, using a standardized institutional switch protocol, in patients with previously treated neovascular age-related macular degeneration (nAMD) who achieved a maximum fluid-free interval of 8 weeks or less with aflibercept or ranibizumab. METHODS: Retrospective, single-center cohort study conducted at Croix-Rousse Hospital, Lyon and included eyes with a maximum fluid-free interval of 8 weeks or less on aflibercept or ranibizumab, switched to faricimab between November 2023 and December 2024. Eyes were classified as Poor Responders (PR) or Frequent Flyers (FF) based on their prior anti-VEGF response. No loading dose was administered. Primary outcome was change in last intended treatment interval. Secondary outcomes included best-corrected visual acuity (BCVA), SD-OCT parameters, predictors of interval extension and safety. RESULTS: 128 eyes were included. Before switching, mean (SD) treatment duration was 36.4 (21.9) months with a mean (SD) 28.2 (17.0) intravitreal injections. After switching, the median gain in the last intended interval was 2.7 [IQR 2.1-3.3] weeks (p<0.001). Subgroup analysis showed a median gain of 3.1 weeks in PR (p<0.001) and 2.4 weeks in FF (p<0.001). BCVA remains stable (p=0.37). Significant reductions were observed in CMT (p<0.001), SHRM (p=0.02), IRF (p<0.001), and SRF (p<0.001). Baseline characteristics were not associated with treatment interval extension. There was one case of anterior uveitis and vitritis, which resolved with topical corticosteroid treatment. CONCLUSION: In previously treated nAMD patients, switching to faricimab without a loading dose achieved meaningful treatment interval extension, potentially reducing treatment burden without compromising efficacy.