Real World Experience with Intravitreal Pegcetacoplan for Treating Geographic Atrophy in AMD

Abstract

Purpose : Real-world treatment effects of pegcetacoplan therapy in eyes with geographic atrophy (GA) secondary to age-related macular degeneration (AMD) were assessed by using swept-source optical coherence tomography angiography (SS-OCTA) imaging at baseline and during follow-up visits.

Methods : Eyes with GA secondary to AMD, enrolled in an ongoing prospective SS-OCT imaging study, were treated with 15 mg of intravitreal pegcetacoplan. All eyes underwent SS-OCTA imaging before and during pegcetacoplan therapy to assess for GA lesion size, the presence of nonexudative macular neovascularization (MNV), and the onset of exudation. The growth rate of GA was assessed for all eyes followed for at least 6 months.

Results : From 4/12/2023 to 12/6/2023, 510 intravitreal injections of pegcetacoplan were administrated to 109 eyes from 83 patients. One eye developed vitritis that resolved with topical steroid therapy, and this patient did not receive any additional injections. Overall, including the patient with vitritis,12 eyes were considered lost to follow-up and excluded from the analysis. At baseline, 14 eyes had been previously treated with anti-VEGF therapy, and nonexudative MNV was detected in one of these eyes. Eight eyes were diagnosed with treatment-naïve nonexudative MNV at baseline. During follow-up, 13 eyes (12%) developed exudation, and 9 of these eyes had no detectable MNV and were not treated with anti-VEGF therapy (Figure 1). However, of the 4 eyes (4%) that developed exudation and were treated with anti-VEGF therapy, 1 eye had received previous anti-VEGF therapy without evidence of MNV at baseline (Figure 2), 2 eyes had treatment-naïve nonexudative MNV at baseline, and 1 eye had no detectable MNV at baseline. Of the 20 eyes with at least 6 months of follow-up on therapy, the square root (sqrt) GA growth rate was 0.26±0.16 mm/year. For the 15 eyes with a prior annual visit, the mean interval for that prior visit was 0.98 years. The mean sqrt GA growth rate for these 15 eyes was 0.32±0.14 mm/year before treatment and 0.21±0.13 mm/year after treatment, a decrease in growth rate of 34% (p=0.008).

Conclusions : Pegcetacoplan therapy reduced the annual growth rate of GA by 34% while causing exudation in 12% of eyes over 6 months, but only 4% of eyes required anti-VEGF therapy. While longer follow-up is needed, pegcetacoplan therapy appears effective for slowing the growth of GA in a real-world setting.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.