In retinal vein occlusion, aflibercept 8 mg reached driving vision more often; faricimab dried the macula more often

Design

Systematic review and frequentist network meta-analysis

Population

2,174 adults with macular oedema from retinal vein occlusion in 3 trials

Primary outcome

Visual acuity and anatomical outcomes at end of loading

Effect

BCVA ≥69 letters: RR 1.18 (1.03–1.35) favouring aflibercept 8 mg; fluid resolution RR 1.12 (1.01–1.25) favouring faricimab

This network meta-analysis indirectly compared aflibercept 8 mg and faricimab for macular oedema due to retinal vein occlusion, using three trials with 2,174 adults and four-weekly aflibercept 2 mg as the common comparator, at the end of loading (24–40 weeks).

Mean visual gain did not differ. Aflibercept 8 mg every 8 weeks after five monthly loading doses was more likely than four-weekly faricimab to reach 69 letters or better, the unconditional driving standard (RR 1.18, 95% CI 1.03–1.35). Faricimab was more likely to achieve complete resolution of intraretinal and subretinal fluid (RR 1.12, 1.01–1.25). Clinically significant pressure rise 30–60 minutes after injection was more frequent with aflibercept 8 mg (RR about 6.4–7.0) than with faricimab.

The practical choice between these agents will be driven by cost, access and injection burden more than these modest differences. The pressure finding is worth acting on: check intraocular pressure after high-dose injections, especially in glaucomatous eyes.

• Check intraocular pressure after aflibercept 8 mg injections, especially in eyes with glaucoma
• Choose between agents on access, cost and interval as much as on these indirect differences
• Record visual acuity against driving thresholds when counselling working-age patients
• Do not treat anatomical dryness alone as the treatment goal

Why it matters

Clinicians choosing a longer-acting agent for vein occlusion now have a sense of the trade-offs between vision, drying and pressure spikes.

Don't overread it

An indirect network comparison of three trials — not a head-to-head result.

The statistics, in plain English

These are indirect comparisons through a shared comparator, not head-to-head trials, so they are weaker than a direct trial. The pressure-rise risk ratios have very wide intervals (1.85 to 22.34) because events were few, so the true size of that difference is uncertain even though its direction is consistent.

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