Evaluating the effectiveness of modern Anti VEGF therapies in a regional Australian hospital

Modern anti–vascular endothelial growth factor (VEGF) agents, including aflibercept 8 mg (Eylea HD) and Faricimab (Vabysmo), have shown promise in extending treatment intervals while maintaining or improving visual acuity in chronic retinal diseases such as neovascular age-related macular degeneration (nAMD), diabetic macular oedema (DMO), and central serous chorioretinopathy (CSCR). These newer therapies aim to reduce the treatment burden associated with frequent intravitreal injections. However, real-world data, especially from regional Australian clinical settings, remain limited, despite potential differences in patient demographics, healthcare access, and adherence compared to controlled clinical trials. This retrospective audit evaluated clinical outcomes of patients transitioned from first- generation anti-VEGF agents (ranibizumab or aflibercept 2 mg) to modern agents (aflibercept 8 mg or Faricimab) at a regional hospital over a 12-month period (September 2024 to September 2025). Patients were eligible if they had a diagnosis of nAMD, DMO, or CSCR; had previously received intravitreal injections of a first-generation anti-VEGF agent; and were subsequently switched to aflibercept 8 mg or Faricimab.

Additionally, inclusion required that patients had received at least three consecutive injections of the modernagent to ensure adequate exposure and undergone at least one post-switch clinical review documenting best corrected visual acuity (BCVA). There were no restrictions on patient ageor sex to reflect real-world diversity. Data collected included demographics, diagnosis, treatment intervals before and after switching, BCVA, agent used, and rationale for switching, categorised as quiescent disease aimed at interval extension or persistent active disease.

Among 206 patients (105 receiving aflibercept 8 mg and 101 receiving Faricimab), 73% of those in the aflibercept group were switched due to recurrent disease activity, while 27% were switched during periods of quiescence with the goal of extending treatment intervals. Overall, 51% of patients in this group achieved an extension of their treatment intervals, with an average increase of 10 days. Notably, among those who experienced interval extension, 86% maintained or improved their visual acuity at their follow-up after switching. In the Faricimab cohort, 61% of patients were switched due to recurrent activity, and 39% during quiescence. Here, 65% of patients successfully extended their treatment intervals, with an average increase of 16 days between injections. Among patients who achieved interval extension, 78% maintained or improved their visual acuity at the post-switch review. In patients who did not achieve interval extension, 87% in the aflibercept group and 68% in the Faricimab group were switched due to active disease.

These findings demonstrate that in a regional Australian clinical setting, switching to modern anti-VEGF agents can effectively extend treatment intervals and preserve visual outcomes, particularly in patients with quiescent disease. This real-world evidence supports the use of aflibercept 8 mg and Faricimab to reduce treatment burden while maintaining efficacy outside the controlled environment of clinical trials. Further prospective studies are warranted to optimize treatment protocols and improve long-term patient outcomes in diverse populations.