Combined anti-ang2/tie and anti-vegf intravitreal therapy in age-related macular degeneration - a systematic review

Age-related macular degeneration is a multifactorial condition, associated with the degeneration of the retinal pigment epithelium (RPE) at the macular level and subretinal neovascular membranes. The use of anti-VEGF agents has brought significant improvements in the control of the disease, but it continues to represent one of the main causes of irreversible blindness in the world's elderly population. Recently, faricimab, a new bispecific, anti-VEGF and anti-ANG2/Tie agent was approved in the therapy of neovascular age-related macular degeneration (nAMD). A systematic review was carried out on Web of Science and PubMed to document the efficiency and safety of intravitreal therapy with faricimab. After removing duplicates and applying the exclusion and inclusion criteria, 16 studies were identified, on a total of 2970 patients with nAMD, with a mean follow-up period of 24.27 +/- 13.3 weeks. In naive patients, intravitreal therapy with faricimab was comparable to anti-VEGF in terms of anatomical and functional results, but allowed spacing of injections after the loading period. In patients with suboptimal response or with a switch from anti-VEGF therapy, faricimab did not significantly improve visual acuity, but reduced retinal and/or choroidal thickness. Intravitreal faricimab is a safe and effective therapy, with prolonged control of the disease in most cases, improving the patients' quality of life.