Efficacy and safety after switching to faricimab in previously treated neovascular age-related macular degeneration: a systematic review and meta-analysis

Switching to faricimab in previously treated neovascular age-related macular degeneration (nAMD) has been widely adopted in clinical practice, yet pooled quantitative evidence supporting this strategy remains limited. This systematic review and meta-analysis evaluated anatomical, functional, treatment interval, and safety outcomes after switching to faricimab in pretreated nAMD eyes. A systematic literature search of PubMed/MEDLINE, Embase, and the Cochrane Library from database inception to 31 January 2025 identified observational and cohort studies reporting outcomes after switching. Random-effects meta-analyses were performed using pooled mean change from baseline (positive values indicating reduction) with sensitivity analyses. Twenty studies comprising 1921 eyes were included, with most cohorts consisting of heavily pretreated patients with treatment-resistant disease. Best-corrected visual acuity remained stable without significant pooled changes at 1 month (− 0.004 logMAR; 95% CI − 0.021 to 0.013; p = 0.620), 3 months (− 0.009; 95% CI − 0.050 to 0.032; p = 0.634), 6 months (0.004; 95% CI − 0.015 to 0.022; p = 0.661), and 12 months (0.024; 95% CI − 0.030 to 0.077; p = 0.292). In contrast, central subfield thickness decreased significantly at all evaluated time points, with pooled reductions of 20.135 μm (95% CI 14.881–25.388; p < 0.0001) at 1 month, 37.759 μm (95% CI 24.313–51.204; p = 0.0001) at 3 months, 32.011 μm (95% CI 11.236–52.786; p = 0.009) at 6 months, and 41.245 μm (95% CI 8.684–73.807; p = 0.024) at 12 months. Pigment epithelial detachment height showed a non-significant reduction at 1 month (22.296 μm; 95% CI − 12.017 to 56.609; p = 0.108) but a significant reduction at 3 months (40.953 μm; 95% CI 18.978–62.928; p = 0.0096). Treatment interval outcomes were synthesized descriptively because of heterogeneous reporting; several cohorts demonstrated extension toward approximately 7- to 8-week intervals, whereas some refractory eyes remained on shorter intervals. Faricimab was generally well tolerated, with infrequent and predominantly mild inflammatory adverse events. These findings suggest that switching to faricimab is a safe treatment strategy that provides consistent anatomical improvement while maintaining visual stability in heavily pretreated patients with nAMD.