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Purpose <p>To compare real-world effectiveness of faricimab versus aflibercept as second-line therapies for neovascular age-related macular degeneration (nAMD).</p> Methods <p>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.</p> Results <p>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; <i>p</i> = 0.048) and numerically lower baseline CMT (332.7 ± 107.9 vs. 367.5 ± 103.5&#xa0;μm; <i>p</i> = 0.057). At final follow-up, faricimab achieved a significant BCVA gain (− 0.16 ± 0.42 logMAR; <i>p</i> &lt; 0.001), while aflibercept maintained stable vision (<i>p</i> = 0.923). Both agents significantly reduced CMT (<i>p</i> &lt; 0.001), with a greater mean reduction observed in the aflibercept group (− 96.7 ± 127.5 vs. − 56.8 ± 132.0&#xa0;μm; <i>p</i> = 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; <i>p</i> = 0.906), and switching to third-line therapy occurred less frequently in the faricimab group (4.8% vs. 12.8%; <i>p</i> = 0.065). Baseline BCVA predicted visual gain (B = − 0.199; <i>p</i> = 0.010) and baseline CMT predicted anatomical improvement (B = − 0.517; <i>p</i> &lt; 0.001).</p> Conclusion <p>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.</p>

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Real-world comparison of faricimab and aflibercept as second-line therapies for neovascular age-related macular degeneration

  • 期刊论文

  • 发表日期：

    2026年7月2日

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  • Noah Benjamin Nagar,
  • Michael Ostrovsky,
  • Nir Shoham-Hazon,
  • Raman Tuli,
  • Thomas Kin Man Lee,
  • Noy Buchnick,
  • Sagiv Beluga,
  • Luiza Bramnik,
  • Eilon Shcolnik,
  • Shalhevet Goldfeather Ben Zaken,
  • Niv Levy,
  • Mor Bareket,
  • Efraim Berco

摘要

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.