Page 141 - Ebook-Book JCMS 2025

Comparative Efficacy and Safety of Novel Anti-VEGF Agents versus
Aflibercept for Diabetic Macular Edema: A Meta-Analysis of
Visual Acuity Gains, Anatomical Improvements, and Ocular
Adverse Events
Natchanon Champreeda*
Faculty of Medicine, Chulalongkorn University
*Corresponding Author E-mail: natchanon.cha@docchula.com
Background: Methods: Results: Conclusions: Abstract
Diabetic macular edema (DME) is a leading cause of vision loss globally and commonly
managed with intravitreal anti-VEGF injections. Although effective, conventional agents like
aflibercept require frequent dosing, posing challenges in clinical practice. Novel anti-VEGF
agents, such as faricimab and brolucizumab, offer extended dosing intervals and potential
for improved efficacy. However, their safety profiles remain a concern. This meta-analysis
compares the efficacy and safety of these agents versus aflibercept to inform optimal DME
management.
A systematic search of PubMed, MEDLINE, and Scopus (2020–2025) identified studies
comparing faricimab or brolucizumab with aflibercept for DME. Outcomes included
changes in best-corrected visual acuity (BCVA), ≥15-letter ETDRS responder rates, central
subfield thickness (CST) reduction, and ocular adverse events. Only studies with ≥3-month
follow-up were included. Subgroup analyses were conducted by agent type, prior treatment
history (treatment-naΪve vs. experienced), and dosing regimen (fixed-dose vs. personalized
treatment interval [PTI]).
Eleven studies (10 RCTs, 1 observational; 3,793 eyes) were included—seven (2,489 eyes)
evaluated faricimab vs. aflibercept, and four (1,304 eyes) assessed brolucizumab vs.
aflibercept. Faricimab vs. Aflibercept: Faricimab significantly improved BCVA (MD: 1.37
[0.45–2.28], p = 0.004), CST reduction (MD: 22.84 [18.29–27.37], p < 0.00001), and
responder rates (RR: 1.13 [1.05–1.22], p = 0.002). Fixed-dose regimens led to better CST
outcomes than PTI. Brolucizumab vs. Aflibercept: Brolucizumab improved BCVA (MD: 1.32
[0.52–2.12], p = 0.001) and CST (MD: 28.86 [15.60–42.12], p < 0.00001). Treatment-naΪve
patients showed greater CST reduction; however, only treatment-experienced patients
had higher responder rates (p = 0.01). Safety: No significant differences in serious ocular
adverse events were observed among agents (p = 1.00).
Conclusions Faricimab and brolucizumab offer superior efficacy to aflibercept with
comparable safety profiles. Treatment selection should consider patient-specific factors.
Further studies are needed to clarify long-term outcomes and cost-effectiveness.
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