DUAL-PATHWAY INHIBITION VS VEGF INHIBITION ALONE: A CLINICALCOMPARISON OF FARICIMAB AND AFLIBERCEPT IN DIABETIC MACULAR EDEMA, A SYSTEMATIC REVIEW

Abstract

Diabetic macular edema (DME) is one of the most common causes of vision loss in the world.   Patients and healthcare systems have to deal with the reality that they need to get regular injections of anti-vascular endothelial growth factor (VEFG) medications like aflibercept, which is a standard treatment.   The novel bispecific antibody faricimab can improve anatomical response and lengthen dose intervals since it blocks two pathways at once.  It goes after both VEFG-A and angiopoietin-2 (Ang-2).   To better manage DME, we want to evaluate Faricimab with Aflibercept side by side in terms of safety, effectiveness, long-term effects, and anatomical outcomes.   We utilized the PRISMA 2020criteria to search PubMed, MEDLINE, and the Cochrane Library in a systematic way from 2012 to November 2025.   Researchers used a number of different types of studies, such as randomized controlled trials, subgroup analyses, real-world studies, and network meta-analyses, to compare Faricimab to Aflibercept.   We looked at the treatment intervals, safety signals, central retinal thickness, and best-corrected visual acuity (BCVA) as outcomes.   The outcomes:  Twenty research passed the requirements for inclusion. These included meta-analyses, real-world cohorts, and important phase-3 trials like YOSEMITE and RHINE.   In all of the studies, Faricimab worked better than Aflibercept in increasing BCVA, drying out anatomy, lowering CRT, and speeding up fluid resolution.   A far bigger percentage of eyes treated with Faricimab were able to cut down on the number of injections they needed each year by keeping their dose intervals at 12 to 16 weeksThere were no significant warnings of systemic or ocular side effects in either treatment, and their safety profiles were quite comparable.    

Conclusion: Faricimab substantially improves anatomical outcomes and greatly lengthens the term of treatment, while delivering functional outcomes that are similar to Aflibercept.     It is less required to get shots and see the doctor if you block both the VEFG-A and Ang-2.   This makes it a good first-line or early switch treatment for DME, especially in countries where there don't belong to many resources and treatment is hard to get