Switching to faricimab after prior anti-vascular endothelial growth factor therapy for persistent diabetic macular edema: a systematic review and meta-analysis

To assess functional and anatomical results of switching to faricimab after prior anti-vascular endothelial growth factor (anti-VEGF) therapy with bevacizumab and/or ranibizumab and/or aflibercept in persistent diabetic macular edema (DME).

We performed a systematic search of literature across four primary electronic databases (PubMed, Embase, Web of Science, and Scopus) prior to January 2025 to find the articles on switching to faricimab in refractory DME. Therapeutic effect parameters, including mean change of best-corrected visual acuity (BCVA), central macular thickness (CMT) and injection intervals were extracted from baseline to different follow-up timelines.

Six hundred twenty-nine eyes from 564 patients of fifteen studies, published between 2022 and January 2025, were included in this systematic review, all of which employed a retrospective cohort design. Most participants in the included studies had prior anti-VEGF therapies which were predominantly aflibercept, with fewer cases received ranibizumab and/or bevacizumab. Meta-analysis showed that BCVA improved significantly () in both 1 month and 3 to 12 months after switching. The pooled mean difference was - 0.03 (95%CI: -0.06 to -0.01, ) at 1 month post faricimab injection and - 0.05 (95% CI: -0.08 to -0.03, ) at 3-12 months. CMT also showed significant improvement after switching to faricimab in different follow up periods including even one month and 3-12 months after first faricimab injection. The pooled mean difference was - 54.69 and - 103.5 μm, respectively. Moreover, the pooled results from six studies indicate a significant prolongation in treatment intervals, with a mean difference of 1.53 weeks.

Based on this meta-analysis, switching to faricimab can be considered for patients with persistent DME and can lead to functional or anatomical improvement.