Objective:

To evaluate the long-term effects of faricimab in patients with neovascular age-related macular degeneration (nAMD) over a 3- to 4-year extension trial, focusing on visual acuity, anatomical changes, and treatment frequency.

Key Findings:

• BCVA, anatomy, and central subfield thickness remained stable over the course of the extension, indicating effective long-term management.
• 44% fewer patients who switched from aflibercept to faricimab had persistent retinal fluid at the end of year 4, highlighting the potential benefits of switching therapies.
• Over 60% of patients achieved a maximum extension interval of 16 weeks, suggesting improved treatment adherence and outcomes.

Interpretation:

The results suggest that faricimab may provide more durable treatment outcomes compared to traditional anti-VEGF therapies, potentially bridging the gap between clinical trials and real-world data, particularly due to its dual mechanism of action.

Limitations:

• The study did not analyze the development of macular atrophy related to chronic anti-VEGF use, which could impact long-term outcomes.
• Further analysis is needed to confirm long-term safety and efficacy, and to address potential biases in patient selection.

Conclusion:

The AVONELLE-X trial indicates that faricimab is a promising long-term treatment option for nAMD, maintaining vision stability and reducing the need for frequent injections, which could significantly impact clinical practice.