Comparative Clinical Outcomes of Faricimab Versus Aflibercept in Diabetic Macular Edema: A Focused Review

This manuscript presents a focused narrative review with systematic literature identification of comparative evidence on faricimab versus aflibercept in adults with diabetic macular edema. The review prioritized randomized phase III evidence and selected only clinically decisive extension, post hoc, and real-world studies published from 2022 through 2025. The predefined PICO was: adults with DME; intervention faricimab; comparator aflibercept; outcomes best-corrected visual acuity, central subfield thickness, injection burden and durability, and safety. The core evidence base consisted of the YOSEMITE and RHINE randomized trials and their 2-year follow-up, supplemented by FDA regulatory documents and a small number of directly relevant post hoc and real-world studies. At year 1, faricimab achieved noninferior visual gains versus aflibercept in both trials, with numerically greater reductions in central subfield thickness. At year 2, visual acuity remained comparable, whereas anatomic outcomes and durability continued to favor faricimab, especially in the treat-and-extend arm, in which more than 60% of patients were on every-16-week dosing and approximately 80% were on every-12-week-or-longer dosing by week 96. Safety was broadly similar across randomized arms, although postmarketing retinal vasculitis warnings require continued pharmacovigilance. Direct real-world head-to-head evidence remained sparse; available switch studies suggest benefit primarily in selected aflibercept-refractory eyes. Overall, the present evidence supports faricimab as a clinically relevant alternative to aflibercept in DME when durability and anatomic control are prioritized, but not as a superior agent for letter gain alone.