Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2026
Real-world comparison of faricimab and aflibercept as second-line therapies for neovascular age-related macular degeneration.
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Nagar Noah Benjamin, Ostrovsky Michael, Shoham-Hazon Nir, Tuli Raman, Lee Thomas Kin Man, Buchnick Noy, Beluga Sagiv, Bramnik Luiza, Shcolnik Eilon, Goldfeather Ben Zaken Shalhevet, Levy Niv, Bareket Mor, Berco Efraim
Аннотация
PURPOSE: To compare real-world effectiveness of faricimab versus aflibercept as second-line therapies for neovascular age-related macular degeneration (nAMD).
METHODS: This multicenter retrospective cohort study included patients with nAMD who switched to faricimab or aflibercept as second-line anti-VEGF therapy and were followed ≥ 12 months. Outcomes included best-corrected visual acuity (BCVA, logMAR), central macular thickness (CMT, µm), injection intervals, and switching rates. Multivariable linear regression identified predictors of visual and anatomical change.
RESULTS: A total of 170 eyes (84 faricimab, 86 aflibercept) were analyzed. Faricimab-treated eyes had worse baseline BCVA (0.60 ± 0.49 vs. 0.47 ± 0.37 logMAR; p = 0.048) and numerically lower baseline CMT (332.7 ± 107.9 vs. 367.5 ± 103.5 μm; p = 0.057). At final follow-up, faricimab achieved a significant BCVA gain (- 0.16 ± 0.42 logMAR; p < 0.001), while aflibercept maintained stable vision (p = 0.923). Both agents significantly reduced CMT (p < 0.001), with a greater mean reduction observed in the aflibercept group (- 96.7 ± 127.5 vs. - 56.8 ± 132.0 μm; p = 0.046). Final BCVA and CMT did not differ significantly between groups. Final injection intervals were similar between groups (7.5 ± 2.9 vs. 7.6 ± 3.1 weeks; p = 0.906), and switching to third-line therapy occurred less frequently in the faricimab group (4.8% vs. 12.8%; p = 0.065). Baseline BCVA predicted visual gain (B = - 0.199; p = 0.010) and baseline CMT predicted anatomical improvement (B = - 0.517; p < 0.001).
CONCLUSION: In this real-world multicenter cohort, both faricimab and aflibercept were associated with visual and anatomical improvement after switching to second-line therapy for nAMD. No statistically significant difference in final BCVA, final CMT or injection interval was observed between treatment groups. Baseline disease severity predicted treatment response. Given the retrospective design and residual confounding, these findings should be interpreted as associative rather than causal.
METHODS: This multicenter retrospective cohort study included patients with nAMD who switched to faricimab or aflibercept as second-line anti-VEGF therapy and were followed ≥ 12 months. Outcomes included best-corrected visual acuity (BCVA, logMAR), central macular thickness (CMT, µm), injection intervals, and switching rates. Multivariable linear regression identified predictors of visual and anatomical change.
RESULTS: A total of 170 eyes (84 faricimab, 86 aflibercept) were analyzed. Faricimab-treated eyes had worse baseline BCVA (0.60 ± 0.49 vs. 0.47 ± 0.37 logMAR; p = 0.048) and numerically lower baseline CMT (332.7 ± 107.9 vs. 367.5 ± 103.5 μm; p = 0.057). At final follow-up, faricimab achieved a significant BCVA gain (- 0.16 ± 0.42 logMAR; p < 0.001), while aflibercept maintained stable vision (p = 0.923). Both agents significantly reduced CMT (p < 0.001), with a greater mean reduction observed in the aflibercept group (- 96.7 ± 127.5 vs. - 56.8 ± 132.0 μm; p = 0.046). Final BCVA and CMT did not differ significantly between groups. Final injection intervals were similar between groups (7.5 ± 2.9 vs. 7.6 ± 3.1 weeks; p = 0.906), and switching to third-line therapy occurred less frequently in the faricimab group (4.8% vs. 12.8%; p = 0.065). Baseline BCVA predicted visual gain (B = - 0.199; p = 0.010) and baseline CMT predicted anatomical improvement (B = - 0.517; p < 0.001).
CONCLUSION: In this real-world multicenter cohort, both faricimab and aflibercept were associated with visual and anatomical improvement after switching to second-line therapy for nAMD. No statistically significant difference in final BCVA, final CMT or injection interval was observed between treatment groups. Baseline disease severity predicted treatment response. Given the retrospective design and residual confounding, these findings should be interpreted as associative rather than causal.