AMD Outcomes in Patients Treated with PCSK9 Inhibitors: A Descriptive Cohort

Abstract

Purpose : To analyze a cohort of individuals diagnosed with age-related macular degeneration (AMD) during treatment with PCSK9 inhibitors (PCSK9i).

Methods : A retrospective review of AMD patients who initiated treatment with either alirocumab or evolocumab at Mass General Brigham between 3/1/2016-10/27/2023 was performed. Patients taking a PCSK9i for <6 months were excluded. Demographics, duration of PCSK9i use, total cholesterol (TC), low-density lipoprotein (LDL), known AMD risk factors, and AMD duration prior to PCSK9i initiation were also recorded.

Results : A total of 22 eyes from 11 patients (52.2% female), with a median age of 77 years were identified. At baseline, median TC was 178 mg/dL, median LDL was 118 mg/dL, 64.7% were former smokers, and 23.5% had type 2 diabetes (T2D). Four eyes (4/22; 18.2%) had a baseline diagnosis of early AMD, 13/22 eyes (59.1%) had intermediate AMD, and 5/22 eyes (22.7%) had advanced AMD (geographic atrophy (GA) and/or exudative AMD). Three of 22 (13.6%) eyes progressed to intermediate AMD, 3/22 eyes (13.6%) progressed to advanced nonexudative AMD (GA), and 3/22 eyes (13.6%) progressed to exudative AMD. In those that progressed (7 patients; 57.1% female), median age was 78 years with a median AMD duration prior to PCSK9i initiation of 2.9 years, median baseline TC of 178 mg/dL, median baseline LDL of 118 mg/dL. In those with no progression (4 patients; 50% female), median age was 75 years with a median AMD duration prior to PCSK9i initiation of 2.5 years.

Conclusions : Patients with AMD on PCSK9i progress at an equal or higher rate than expected. This may signify that patients requiring PCSK9i are worse progressors or progress due to drug effect. This study is limited by the very small numbers and the retrospective nature and cannot discriminate between drug effect or if patients requiring PCSK9i are already at increased risk of progression.

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