OBJECTIVES: A network meta-analysis (NMA) was conducted comparing the relative efficacy of Faricimab and anti-vascular endothelial growth factor(VEGF) treatments for diabetic macular edema (DME) in China.

METHODS: PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, Wanfang, CNKI, and VIP databases were systematically searched for randomized controlled trials (RCTs) on anti-VEGF therapy of DME in Chinese population from inception to December 2023. The primary outcomes considered mean change from baseline in best-corrected visual acuity (BCVA), central macular thickness (CMT), 25-item Visual Function Questionnaire (VFQ-25) scores, injection frequency, and the proportion of patients gaining at least 15 Early Treatment Diabetic Retinopathy Study (ETDRS) letters at 1-year follow-up. All relevant data were analyzed using the netmeta package in R 4.3.1.

RESULTS: A total of 4 RCTs were included in the NMA. At 1-year follow-up, the faricimab every 8 weeks (Q8) group had a statistically better BCVA improvement than ranibizumab (MD=12.30; 95% CI: 4.54, 20.06) , conbercept (MD=9.70; 95% CI: 1.78, 17.62), aflibercept Q8(MD=4.00; 95%CI: 1.19, 6.81)and laser treatment. The faricimab personalised treatment interval (PTI) group also obtained a statistical improvement than ranibizumab (MD=10.60; 95%CI: 2.68, 18.52). In addition, faricimab Q8 and PTI regimens got statistically higher CMT reduction compared with ranibizumab, conbercept and aflibercept Q8 treatment (decreased by 39.70 to 129.10 microns). In terms of all outcome results, faricimab Q8 and faricimab PTI had the highest probability of being the most effective options.

CONCLUSIONS: This NMA showed intravitreal faricimab regimens resulted in statistically beneficial effects on BCVA improvement and CMT reduction, also had the highest probability of being the most effective options in VFQ-25 scores, number of injections and a higher proportion of patients with a gain of at least 15 ETDRS letters compared to ranibizumab, conbercept, aflibercept or laser group after one-year treatment in China.