Real-world outcomes of faricimab in treating diabetic macular edema up to two years

Purpose: To evaluate real-world outcomes of faricimab in treating diabetic macular edema (DMO) in treatment-naive and treatment-switch patients. Design: Retrospective audit. Methods: All patients with DMO initiating 6 mg faricimab at a London hospital between 01/01/2022-02/02/2024 were included. The protocol comprised four four-weekly loading doses followed by a treat-and-extend regimen tailored to response. Data collected included demographics, best-corrected visual acuity (BCVA), and central macular thickness (CMT). Results: Overall, 65 patients (87 eyes) received faricimab; 34 eyes (39.1%) were treatment-naive, and 53 eyes (60.9%) had switched from other treatments. In the treatment-naive group (24 patients; mean follow-up 8 months, SD = 3.8; 3–8 injections), mean age was 66 years (SD = 10), baseline VA: 59.5 EDTRS (SD = 13), and CMT: 485.1 μm (SD = 80), reducing to 327.2 μm (SD = 70; P < 0.0001). Final VA was 62.7 EDTRS (SD = 14; P = 0.259). The treatment-switched group (41 patients, 53 eyes) had a mean age of 65 (SD = 11) years. A total of 32 eyes (60.4%) had a single prior treatment; 25 had received aflibercept, four eyes had received ranibizumab, and three eyes had received dexamethasone implants. The other 21 (39.6%) eyes had combinations of these medications. Patients received 2–11 faricimab injections. Mean follow-up was 8.4 months (SD = 3.9), initial VA: 59.7 EDTRS (SD = 12.9), and CMT: 439.5 μm (SD = 102), decreasing to 366.9 μm (SD = 80.7) ( P < 0.0001); final VA was 61.4 (SD = 15.4) ( P = 0.55). Conclusion: Faricimab significantly reduced CMT in both groups, with a greater reduction in treatment-naive eyes. VA improvement was, however, not statistically significant. Further studies are warranted to explore factors influencing visual outcomes.