Switch to faricimab after initial treatment with aflibercept in eyes with diabetic macular edema

Purpose To assess the effectiveness of a switch to faricimab in individuals affected by DME and previously treated with aflibercept. Methods In this retrospective, single-center study, DME patients previously treated with at least 3 injections of aflibercept then switched to faricimab were enrolled. Best corrected visual acuity (BCVA) and central subfield thickness (CST) were recorded at baseline, at the time of the switch and at 6 months follow-up. At transition to faricimab, patients were categorized as "good visual responders" (>= 5 letters from baseline) or "poor visual responders" (< 5 letters), and as "good anatomical responders" (any reduction in edema compared to baseline) or "poor anatomical responders" (no reduction or worsening of edema). Changes in BCVA and CST were recorded at 6 months after the switch to faricimab. Results 100 eyes of 100 patients (61 female, 61%) were switched to faricimab after a mean of 6.8 +/- 3.3 aflibercept injections. At the 6 months follow-up, only "poor visual responders" (N = 62) demonstrated a meaningful increase in BCVA (Delta switch-6M = + 5 letters; P = 0.007), coupled with a reduction in CST (Delta switch-6M = - 67.9 <mu>m; P = 0.004); participants with "poor anatomical response" upon transitioning exhibited a significant functional gain (Delta switch-6M = + 4.5 letters; p = 0.05) but limited CST enhancements (Delta switch-6M = - 95.1 mu m; p = 0.05). Conclusions Faricimab shows a positive impact on anatomical and functional metrics in DME cases refractory to aflibercept.