[Indirect comparison of anti-angiogenic agents in the treatment of diabetic macular edema].

Unlabelled: Diabetic macular edema (DME) is a leading cause of visual impairment and blindness among diabetic patients, its prevalence is continuing to increase worldwide. Faricimab, a bispecific antibody, represents a new generation of treatments for DME.

Purpose: This study presents an indirect comparison of the effectiveness and safety of faricimab versus other treatment options for DME.

Material And Methods: This systematic review of the effectiveness and safety of intravitreal injections (IVIs) of anti-angiogenic agents was conducted using the PRISMA methodology. Randomized clinical trials (RCTs) with outcomes at 12 months of DME treatment were included for network meta-analysis (NMA). Six endpoints were evaluated: the change in best-corrected visual acuity (BCVA), central retinal thickness (CRT); number of IVIs; proportion of patients with improved/deteriorated vision (per ETDRS); incidence of ophthalmic adverse events; and probability of treatment discontinuation. Evidence network diagrams and forest plots for faricimab 6.0 mg in a personalized treatment interval (PTI) regimen (up to one injection every 16 weeks) compared to aflibercept 2 mg and ranibizumab 0.5 mg were generated using RStudio.

Results: Of 2845 initial publications, 38 studies were reviewed, and 20 RCTs were included in the base NMA. A random-effects model was applied for the NMA of injection frequency due to high heterogeneity, while fixed-effect models were used for other endpoints. Faricimab 6 mg in the PTI regimen demonstrated superior or comparable functional (BCVA improvement) and anatomical (CRT reduction) outcomes over 12 months with fewer injections than aflibercept 2 mg or ranibizumab 0.5 mg. Safety outcomes were similar across all anti-angiogenic agents.

Conclusions: The clinical efficacy and safety of faricimab, aflibercept and ranibizumab are comparable in adult patients with DME with a fewer number of faricimab IVIs vs comparators.