Purpose: Pivotal phase 3 trials for Faricimab and Aflibercept-8mg for treatment-naive neoavascular age related macular degeneration (nAMD) compared their efficacy against Aflibercept-2mg. Due to differing treatment protocols and outcome measures across trials, direct comparison of their efficacy remains challenging. This study aims to address this gap by comparing real-world outcomes of Faricimab and Aflibercept-8 mg in a treatment-naïve nAMD population.

Methods: Retrospective case series of patients diagnosed with treatment-naive nAMD between June 1st and October 31st, 2024 and treated with Faricimab and Aflibercept-8mg at a single tertiary centre. The choice of agent was clinician preference. Based on local departmental protocol, all cases had an initial loading dose of three-monthly injections followed by a review one month later. Regression models were used to identify predictors of clinical outcomes.

Results: A total of 151 eyes (144 patients) were included: 78 eyes treated with Faricimab and 73 with Aflibercept-8mg. Median BCVA improved for both Faricimab, 65 to 70 letters (p=0.0008) and Aflibercept-8mg, 59 to 67 letters (p=<0.0001). Similarly, median CMT improved for both drugs (Faricimab: 330 to 253 microns (p=<0.0001) and Aflibercept-8mg: 368 to 258 microns (p=<0.0001)). Collectively, the presence of any fluid reduced from 100% to 15%, subfoveal PED height reduced from 229µm to 51µm and SRF height reduced from 111µm to 0µm (p’s<0.0001). Injection of Faricimab versus Aflibercept 8mg was not significantly associated with any of the outcomes.

Conclusion: According to this real-world, single-centre study carried out under a standardised loading protocol, Faricimab and Aflibercept-8 mg produce similar early improvements in visual and anatomical outcomes in treatment-naïve nAMD.