Abstract
To report on the real-world experience of using intravitreal pegcetacoplan for the treatment of geographic atrophy (GA) in age-related macular degeneration (AMD).
Retrospective interventional case series.
Eyes with symptomatic GA secondary to AMD were treated with 15mg of intravitreal pegcetacoplan and participated in an ongoing prospective swept-source optical coherence tomography angiography (SS-OCTA) imaging study. All eyes underwent SS-OCTA imaging before and during pegcetacoplan therapy to assess for GA lesion size, the presence of non-exudative macular neovascularization (MNV), and the onset of exudation. The growth rate of GA and best-corrected visual acuity (BCVA) were assessed for eyes followed for 1 year.
From April 12, 2023, to November 11, 2024, 154 eyes were injected with pegcetacoplan, and 103 eyes had 1-year follow-up. At baseline, 11 eyes had been previously treated with anti-VEGF therapy, and 9 eyes were diagnosed with treatment-naïve non-exudative MNV by SS-OCTA. Each eye received an average of 10±2 injections, with an average interval of 1.2 months between injections. For the 97 eyes with 1 year of follow-up and measurable GA, the square-root (sqrt) GA growth rate after pegcetacoplan treatment was 0.24±0.15 mm/year. Of these 97 eyes, 63 eyes had prior annual visits before pegcetacoplan treatment was started. In these eyes, the annual sqrt GA growth rate was 0.33±0.22 mm/year before pegcetacoplan and 0.21±0.12 mm/year after pegcetacoplan, resulting in a 37% decrease in the growth rate (p<0.001). There were no significant differences in GA growth rate between foveal and non-foveal GA, either before or after the use of pegcetacoplan (all p≥0.80). The mean BCVA declined from 63±14 to 59±15 letters over one year (p=0.001), with no significant difference between foveal and non-foveal GA (p=0.36). Among the 29 eyes developing exudation during pegcetacoplan treatment, 19 (66%) had no evidence of any detectable MNV at baseline and during treatment on SS-OCTA.
Eyes treated with pegcetacoplan after 1 year had a 37% reduction in GA growth rate compared with their prior annual growth rate. Pegcetacoplan slowed the growth for foveal and non-foveal GA at a similar rate. Most of the pegcetacoplan-associated exudation was not due to detectable MNV.