Real-world comparative effectiveness of faricimab versus aflibercept 2 mg in treatment-naïve exudative neovascular AMD patients treated with a treat-and-extend regimen
In brief
Faricimab gives ~3-letter vision gain and one fewer injection yearly
In a real-world cohort of 172 treatment-naïve neovascular AMD patients, faricimab improved best-corrected visual acuity by roughly three letters more than aflibercept after loading and at one year, while patients needed a median of three versus four injections. It also cleared subretinal fluid more often and lowered switch rates, though the non-randomised design limits definitive conclusions.
- Journal
- Eye (London, England) (Q1)
- Published
- 4 August 2026
- Study design
- Non-randomized / quasi-experimental trial
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Xuenan Zhuang, Lorena Ulla, Claudio Foti, Rossella Cariola, Giovanni Neri, Chiara Olivieri, et al.
- PMID
- 42552408
- DOI
- 10.1038/s41433-026-04710-y
Why clinicians should know about it
- Picked for Ophthalmology (paper of the day, 6 August 2026): Non‑randomized trial, faricimab shows superior VA vs aflibercept
Abstract
PURPOSE: To compare the real-world effectiveness of faricimab versus aflibercept 2 mg in treatment-naïve patients with neovascular age-related macular degeneration (nAMD). METHODS: We analysed treatment-naïve nAMD patients aged ≥50 years initiating intravitreal anti-VEGF therapy between March 2024 and September 2024. Patients received either faricimab or aflibercept 2 mg. Inverse probability of treatment weighting was used to minimise selection bias. Primary outcomes were best-corrected visual acuity (BCVA) changes from baseline to post-loading phase and 1-year follow-up. Secondary outcomes included anatomic resolution of intraretinal fluid (IRF), subretinal fluid (SRF), and subretinal hyperreflective material (SHRM), treatment burden, and safety. RESULTS: A total of 172 patients were included (86 faricimab, 86 aflibercept). Baseline characteristics were well-balanced between groups. The faricimab regimen was associated with greater BCVA improvement compared with aflibercept at post-loading phase (adjusted mean difference -0.075 logMAR; 95% confidence interval [CI], -0.130 to -0.020; P = 0.008) and at 1 year (-0.073 logMAR; 95% CI, -0.128 to -0.018; P = 0.011). Patients receiving faricimab achieved significantly higher rates of SRF resolution (odds ratio 2.446; 95% CI, 1.012 to 5.912; P = 0.047). The faricimab group was associated with fewer injections from the post-loading phase to 1 year (median 3 vs. 4; P < 0.001) and lower therapy switching rates (7.9% vs. 25.6%; P = 0.003). CONCLUSIONS: In treatment-naïve nAMD patients, faricimab achieved greater visual acuity gains, enhanced anatomic outcomes, and reduced treatment burden compared with aflibercept. However, these findings should be interpreted in light of the non-randomised design, different loading regimens, and potential differences in early treatment exposure.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.