Retina. 2026 Jul 1;46(7):1231-1240. doi: 10.1097/IAE.0000000000004813.
Summary
Initiation of Vabysmo or Eylea HD extended Tx intervals, and better VA vs eyes switched from older agents. Suggests step therapy may compromise outcomes. Retrospective real-world — 12501 eyes. With Spaide editorial.
Abstract
Purpose: To evaluate real-world differences in treatment durability, functional, and anatomic outcomes in patients who initiated or switched to aflibercept 8 mg or faricimab.
Methods: Patients were categorized into four cohorts: 1) initiators of aflibercept 8 mg, 2) initiators of faricimab, 3) switchers to aflibercept 8 mg, and 4) switchers to faricimab. Switchers were further stratified as early (≤5 prior injections) or late (>5 injections). Treatment durability was assessed using the mean treatment interval, defined as the average of the three most recent injection intervals before or after the switch. Multivariate linear regression models were used to assess the independent effect of treatment strategy on durability, best-corrected visual acuity (BCVA), and central subfield thickness (CST).
Results: A total of 10,247 patients (12,501 eyes) with either nAMD, DME, or RVO initiated aflibercept 8 mg or faricimab. Initiators achieved greater mean treatment intervals (10 weeks) than switchers (9 weeks postswitch; P < 0.01). Early switchers showed greater durability and CST reduction (-66 µ m) than late switchers (-19 µ m; P < 0.01). Faricimab initiators had greater durability ( P < 0.01) and CST reductions ( P = 0.01) compared with other cohorts. Medicare coverage was associated with longer durability than Medicare Advantage recipients ( P < 0.01).
Conclusion: In this real-world cohort, initiation of faricimab or aflibercept 8 mg was associated with greater treatment intervals and improved anatomic outcomes compared with eyes that were switched from older anti-VEGF agents. These findings support early initiation of these anti-VEGF therapies and that step-therapy delays may compromise clinical outcomes.
