Examining Real-World Attrition Among Patients Undergoing Complement Inhibitor Intravitreal Therapy for Geographic...

To identify characteristics of patients with geographic atrophy (GA) who received pegcetacoplan or avacincaptad pegol and discontinued treatment.

Two complementary retrospective cohort studies of a large, geographically and demographically diverse, deidentified database were performed. One analysis assessed baseline characteristics. Eyes with 12 months of data were included in a subsequent analysis of follow-up changes/characteristics. Univariate and multivariate mixed-effects Cox proportional hazard and logistic regression models, respectively, were used to estimate the hazard ratio (HR) and odds ratio (OR) of attrition.

A total of 21 914 eyes were identified for the baseline analysis, 14 690 (67%) of which received pegcetacoplan and 7224 (33%) avacincaptad pegol. Mean (±SD) patient age was 82.1 ± 7.85 years. Treatment retention declined between 0 and 12 months. Baseline predictors of attrition were age older than 90 years (HR, 1.26; 95% CI, 1.03-1.55; P = .028), pegcetacoplan treatment (HR, 3.32; 95% CI, 2.92-3.76; P < .001), treated (HR, 1.56; 95% CI, 1.40-1.75; P < .001) and untreated (HR, 1.41; 95% CI, 1.21-1.64; P < .001) neovascular age-related macular degeneration (nAMD), visual acuity of less than 35 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (HR, 1.45; 95% CI, 1.25-1.67; P < .001), and subfoveal GA (HR, 1.15; 95% CI, 1.04-1.27; P = .007). Poor baseline visual acuity remained significant in the adjusted 12-month analysis. Significant predictors included new nAMD (OR, 3.02; 95% CI, 2.35-3.89; P < .001) and a loss of more than 5 ETDRS letters (OR, 1.36; 95% CI, 1.17-1.58; P < .001). nAMD treatment intervals of more than 6 weeks (OR, 0.59; 95% CI, 0.39-0.90; P = .014) and GA treatment intervals of 6 to 8 weeks (OR, 0.56; 95% CI, 0.43-0.74; P < .001) contributed to decreased odds of attrition.

Poor baseline vision and development of new nAMD are associated with patient attrition, and the combination of nAMD and GA and treatment burden challenges patient retention.