A one-year study on the regression effects of aflibercept and faricimab on retinal pigment epithelial detachment

To compare long-term regressive effects on pigment epithelial detachment (PED) between aflibercept and faricimab in type 1 macular neovascularization (MNV).

We analyzed 94 eyes from 92 patients diagnosed with type 1 MNV using multimodal imaging. Seventy-one eyes received intravitreal aflibercept injections (IVA group), and 23 received intravitreal faricimab injections (IVFa group). After three consecutive monthly injections, intervals were adjusted in 2-4 week increments within drug-specific windows (IVA, 4-12 weeks; IVFa, 8-16 weeks) through 1 year. The maximum height (MH) and horizontal maximum diameter (H-MD) of PED were measured using optical coherence tomography before treatment and at 3 months and 1year post-treatment. We also assessed associations between PED change and 1-year dry macula, and explored visual outcomes with using analysis of covariance and logistic models.

MH decreased in both IVA (184 ± 176→126 ± 153 μm at 3 months, P = 0.0003; 124 ± 135 μm at 1 year, P = 0.0005) and IVFa (162 ± 124→83 ± 65 μm, P = 0.0056; 86 ± 71 μm, P = 0.0053). The mean change in MH was not significantly different between groups (P = 0.244). H-MD did not show significant regression in either group. IVFa required fewer injections (6.17 ± 0.39 vs. 7.90 ± 1.99/year; P < 0.0001) and achieved a longer final intended injection interval (14.17 ± 2.53 vs. 8.64 ± 2.90 weeks; P < 0.0001). In multivariable linear regression for percent MH change at 1 year, annual injection number was positively associated with percent change (β = 7.62% points/injection, P = 0.012), whereas drug type was not (P = 0.633), adjusting for baseline MH (β = -0.078/µm, P = 0.016; all VIFs < 2). At 1 year, MH was lower in dry vs. wet macula (90 ± 82 vs. 186 ± 185 μm; P = 0.0004). For vision, ≥ 0.2logMAR gain was predicted by CMT decrease (OR ≈ 1.56 per 100 μm decrease; P = 0.045), while percent PED change was not significant (P = 0.283).

In a treat-and-extend regimen with different label constraints, 1-year PED regression was similar for IVA and IVFa and was achieved with less treatment burden in IVFa. PED regression aligned with dry macula rather than with large visual gains, which instead tracked with retinal thickness recovery.