Efficacy of faricimab secondary to anti-vascular endothelial growth factor agents in patients with neovascular age-related macular degeneration: a systematic review and meta-analysis

Abstract

This study examines the efficacy and safety of faricimab as a secondary treatment for neovascular age-related macular degeneration (nAMD) patients previously treated with anti-vascular endothelial growth factors (anti-VEGF) agents. A literature search was performed on PubMed, EMBASE, and Cochrane Library up to 24 October 2024. Cohort and observational studies reporting functional and anatomical outcomes in nAMD patients switched to faricimab were included. Meta analysis with common and random-effect model was performed using "metagen" package in R version 3.2.1. 446 studies were identified on our preliminary search, of which 20 studies (1007 eyes) with a baseline central macular thickness (CMT) of 342.07 ( ± 110.14) um were included in the final analysis. Switching to faricimab led to significant reductions in CMT at 3 months (Mean difference = -47.08 um, 95% Confidence Interval (CI)= (-66.01, -28.15), p = 0.009) and 6 months post-switch (Mean difference =-44.68 um, 95% CI= (-67.17, -22.20), p = 0.002). Pigment epithelium detachment (PED) height was also reduced at 3 months (Mean difference = -31.71um, 95% CI= (-45.12, -18.30), p = 0.036) and 6 months post-switch (Mean difference = -34.85 um, 95% CI= (-50.19, -19.51), p = 0.011). However, no significant improvements in best corrected visual acuity (BCVA) were observed at 3 months (p = 0.407), 6 months (p = 0.920) or ≥12 months (p = 0.261) post-switch. Treatment intervals were significantly extended (Mean difference=1.87 weeks, 95% CI = (0.41, 33.3), p = 0.019), with a low incidence of serious adverse events. In conclusion, faricimab demonstrates favorable structural benefits, stable functional outcomes and extended treatment intervals as a second-line treatment for nAMD in patients with prior anti-VEGF therapy.