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Introduction <p>Management of highly refractory exudative neovascular age-related macular degeneration (nAMD) remains challenging when multiple antivascular endothelial growth factor (VEGF) therapies fail to control the disease. Faricimab, through dual inhibition of VEGF-A and angiopoietin-2, may represent a potential therapeutic alternative for this difficult-to-treat population. However, real-world evidence in highly refractory nAMD remains limited and is lacking in the Portuguese population.</p> Methods <p>This multicenter, retrospective, real-world study included patients with nAMD highly refractory to previous anti-VEGF therapies who were treated with faricimab and followed for at least 6 months. Functional and anatomical outcomes were assessed, including changes in best-corrected visual acuity (BCVA), central subfield thickness (CST), and evolution of intraretinal fluid (IRF) and subretinal fluid (SRF).</p> Results <p>A total of 46 eyes from 40 patients were included, characterized by a long-standing disease (median [25th percentile (P25); 75th percentile (P75)] duration, 5.0 [3.0; 6.0] years) and a high prior treatment burden (32.0 [24.0; 45.8] anti-VEGF injections and median treatment interval of 4.0 [4.0; 6.0] weeks). After faricimab, functional stability was observed (median change in BCVA of 0.0 [−0.1; 0.1] logMAR). Anatomical outcomes showed improvement, with a median reduction in CST of −12 [−58; 7] µm and complete SRF resolution in 47.8% of eyes. Median treatment intervals of 8.0 [6.0–10.0] weeks were achieved, representing a twofold increase in the median treatment interval.</p> Conclusions <p>In this real-world study of highly refractory nAMD, faricimab was associated with stabilization of functional outcomes and improvement in anatomical outcomes over short- to mid-term follow-up, alongside a twofold increase in treatment-interval length in routine clinical practice. These findings support the clinical relevance of inhibiting angiopoietin-2 (Ang-2) and represent the first evaluation conducted in routine clinical practice in Portugal, with potential implications for treatment burden and patient adherence.</p>

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Real-World Outcomes of Faricimab in Patients with Highly Refractory Neovascular Age-Related Macular Degeneration in Portugal: The REVEAL Study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月14日

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  • Filipe Mira,
  • Sofia Donato,
  • Fernanda Vaz,
  • Filipa Madeira,
  • Maria Picoto,
  • António Mendes,
  • João Beato,
  • Sónia Torres-Costa,
  • Carolina Pinto,
  • Nuno Oliveira,
  • Susana Feliciano,
  • Miguel Lume,
  • Rita Carreiro,
  • Mariana Couto,
  • Ângela Carneiro

摘要

Introduction

Management of highly refractory exudative neovascular age-related macular degeneration (nAMD) remains challenging when multiple antivascular endothelial growth factor (VEGF) therapies fail to control the disease. Faricimab, through dual inhibition of VEGF-A and angiopoietin-2, may represent a potential therapeutic alternative for this difficult-to-treat population. However, real-world evidence in highly refractory nAMD remains limited and is lacking in the Portuguese population.

Methods

This multicenter, retrospective, real-world study included patients with nAMD highly refractory to previous anti-VEGF therapies who were treated with faricimab and followed for at least 6 months. Functional and anatomical outcomes were assessed, including changes in best-corrected visual acuity (BCVA), central subfield thickness (CST), and evolution of intraretinal fluid (IRF) and subretinal fluid (SRF).

Results

A total of 46 eyes from 40 patients were included, characterized by a long-standing disease (median [25th percentile (P25); 75th percentile (P75)] duration, 5.0 [3.0; 6.0] years) and a high prior treatment burden (32.0 [24.0; 45.8] anti-VEGF injections and median treatment interval of 4.0 [4.0; 6.0] weeks). After faricimab, functional stability was observed (median change in BCVA of 0.0 [−0.1; 0.1] logMAR). Anatomical outcomes showed improvement, with a median reduction in CST of −12 [−58; 7] µm and complete SRF resolution in 47.8% of eyes. Median treatment intervals of 8.0 [6.0–10.0] weeks were achieved, representing a twofold increase in the median treatment interval.

Conclusions

In this real-world study of highly refractory nAMD, faricimab was associated with stabilization of functional outcomes and improvement in anatomical outcomes over short- to mid-term follow-up, alongside a twofold increase in treatment-interval length in routine clinical practice. These findings support the clinical relevance of inhibiting angiopoietin-2 (Ang-2) and represent the first evaluation conducted in routine clinical practice in Portugal, with potential implications for treatment burden and patient adherence.