One-year clinical outcomes of four-dose induction versus immediate treat-and-extend faricimab regimens in pretreated neovascular age-related macular degeneration.

BACKGROUND/OBJECTIVES: This study aimed to compare one-year clinical outcomes of two faricimab treatment strategies in patients with previously treated exudative neovascular age-related macular degeneration (nAMD): (1) immediate switch to treat-and-extend dosing (T&E), and (2) initiation with a four-dose induction ("loading") regimen. SUBJECT/METHODS: Retrospective comparing two cohorts of pretreated nAMD patients with 12 months of follow-up who were either switched to Faricimab with immediate T&E dosing (Lucerne protocol, "on-the-fly"), or initiated with a four-dose induction phase (Lugano protocol,"re-loading"). Both cohorts were subsequently managed according to a T&E regimen. Demographic and clinical data, including prior intravitreal agents, best-corrected visual acuity (BCVA), central subfield thickness (CST) on optical coherence tomography (OCT), and length of treatment intervals were analysed. Multivariable models were adjusted for baseline differences. RESULTS: Both cohorts (Lucerne, 183 eyes; Lugano, 33 eyes) were similar in baseline characteristics. BCVA improved by 0.81 ETDRS letters in Lucerne and by 2.42 in the Lugano cohort (p = 0.250). CRT decreased by -38.3 μm in Lucerne and by -57.8 μm in Lugano (p = 0.053). Treatment intervals increased by 2.2 weeks in Lucerne and 3.4 weeks in Lugano (p = 0.092). At 12 months, 15.3% of Lucerne patients and 27.3% of Lugano patients achieved intervals ≥ 12 weeks, with significantly higher odds of extension in Lugano (OR 3.87; p = 0.013). CONCLUSIONS: Both cohorts showed anatomical and functional improvements after switching to faricimab. The Lugano cohort, using a four-dose induction phase, showed longer treatment intervals, suggesting better disease stability. CLINICAL TRIAL NUMBER: Not applicable.