Comparative Efficacy of New Anti-VEGF Agents in Diabetic Macular Edema

Abstract

Background: Diabetic macular edema (DME) is a leading cause of vision impairment in patients with diabetes mellitus, resulting from vascular leakage and accumulation of fluid in the macula.

Objective: To compare the efficacy and safety of Ranibizumab, Aflibercept, and Faricimab in improving visual and anatomical outcomes among patients with diabetic macular edema.

Methods: The Multi-Center study was conducted from June 2024 to June 2025. A total of 225 patients with center-involving DME were enrolled and divided equally into three groups: Ranibizumab (0.5 mg/0.05 mL), Aflibercept (2 mg/0.05 mL), and Faricimab (6 mg/0.05 mL). Each patient received three monthly loading doses followed by pro re nata injections for six months. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were recorded using Snellen chart (logMAR conversion) and optical coherence tomography.

Results: All three agents produced significant improvements in visual acuity and reduction in retinal thickness at six months. The mean BCVA gain was 0.18 ± 0.09 logMAR in the Ranibizumab group, 0.21 ± 0.08 logMAR in the Aflibercept group, and 0.26 ± 0.07 logMAR in the Faricimab group (p = 0.03). Mean CRT reduction was 138.6 ± 46.3 μm, 156.7 ± 49.8 μm, and 173.4 ± 52.1 μm, respectively (p = 0.02). The Faricimab group required the fewest injections (3.5 ± 0.8) compared to Ranibizumab (4.8 ± 0.9) and Aflibercept (4.2 ± 1.0), showing a statistically significant reduction in treatment burden (p = 0.01).

Conclusion: It is concluded that Faricimab demonstrates superior efficacy and longer durability compared to Ranibizumab and Aflibercept in the treatment of diabetic macular edema. By achieving greater improvement in vision and retinal anatomy with fewer injections.