Aflibercept 8 mg versus faricimab for macular oedema due to retinal vein occlusion: a systematic review and network meta-analysis

Aim To indirectly evaluate the comparative efficacy and safety of aflibercept 8 mg and faricimab in treating retinal vein occlusion (RVO)-associated macular oedema. Methods We searched MEDLINE, Embase and Cochrane CENTRAL from inception to 11 December 2025. We performed frequentist network meta-analysis on efficacy and safety outcomes at loading phase completion (24–40 weeks), with 4 weekly aflibercept 2 mg as the common comparator. Results Three trials with 2174 adults were included. 8 weekly aflibercept 8 mg with five 4 weekly loading doses was more likely to achieve a best corrected visual acuity (BCVA) of ≥69 letters (Snellen 20/40, unconditional driving threshold) compared with 4 weekly faricimab (risk ratio (RR) 1.18, 95% CI 1.03 to 1.35). 4 weekly faricimab demonstrated greater rates of complete resolution of intraretinal and subretinal fluid against 8 weekly aflibercept 8 mg with both five and three 4 weekly loading doses (both RR 1.12, 95% CI 1.01 to 1.25). There was no evidence of a difference in mean BCVA improvement between agents. Both aflibercept 8 mg and 2 mg regimens were associated with a greater risk of clinically significant intraocular pressure (IOP) rise of 30–60 min post-injection compared with 4 weekly faricimab (8 weekly aflibercept 8 mg with five 4 weekly loading doses, RR 6.42, 95% CI 1.85 to 22.34; 8 weekly aflibercept 8 mg with three 4 weekly loading doses, RR 6.97, 95% CI 2.02 to 24.08; 4 weekly aflibercept 2 mg, RR 2.12, 95% CI 1.01 to 4.47). Conclusion Aflibercept 8 mg and faricimab show comparable overall visual efficacy for RVO-associated macular oedema. Indirect comparisons suggest aflibercept 8 mg may increase the probability of achieving driving vision, while faricimab may offer greater anatomical drying and a lower risk of acute IOP elevation. PROSPERO registration number CRD420251249785.