Real-world early outcomes of intravitreal faricimab 6-mg and aflibercept 2-mg injection in diabetic macular oedema

BACKGROUND/AIMS: To evaluate real-world, short-term anatomical and functional outcomes of faricimab versus aflibercept 2 mg in diabetic macular oedema (DMO). METHODS: This retrospective, parallel-cohort comparative study included 300 consecutive patients with DMO from Moorfields Eye Hospital. Eligible eyes were treatment-naïve and treatment-experienced not receiving therapy for ≥6 months and subsequently initiated on loading phase of faricimab or aflibercept 2mg. Follow-up was 4 months. Data were collected from the Moorfields electronic medical records system. Changes in visual acuity (VA) and central subfield thickness (CST) from baseline to the fourth injection were analysed using multiple linear regression adjusted for baseline covariates (age, gender, ethnicity, diabetes type, baseline retinopathy status, baseline VA or CST and treatment interval). RESULTS: Of 300 eyes enrolled, 292 were ultimately analysed (191 aflibercept; 101 faricimab), with 246 eyes (84.2%) completing follow-up. Mean unadjusted VA gain was +3.9±10.4 letters with aflibercept and +5.2±11.8 letters with faricimab. Adjusted marginal mean VA gain was +4.2 letters for aflibercept and +4.7 letters for faricimab, with a non-significant difference of -0.5 letters (p=0.7). Baseline VA and treatment interval were significant predictors of functional response, with baseline VA exerting approximately 3.4 times the impact of treatment interval. Mean CST reduction was 87.3±106.1 µm with aflibercept and 113.1±136.7 µm with faricimab. Adjusted mean reductions were 95.4 µm and 99.8 µm, respectively (difference -4.4 µm, p=0.7). Baseline CST was the only independent predictor of anatomical response. CONCLUSION: Faricimab and aflibercept achieved comparable short-term anatomical and functional outcomes, with greater anatomical improvement associated with higher baseline CST and larger visual gains observed with lower baseline VA. Treatment interval influenced functional response, underscoring the importance of timely therapy. Baseline disease features and treatment adherence are key determinants of early outcomes, rather than drug selection.