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Two-Year Experience with Intravitreal Pegcetacoplan for the Treatment of Geographic Atrophy in Clinical Practice
Mengxi Shen1, Winston Z Lam1, Alessandro Berni2
1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
Purpose:
To report the 2-year experience of using intravitreal pegcetacoplan for the treatment of geographic atrophy (GA) in age-related macular degeneration (AMD).
Design:
Retrospective interventional case series.
Methods:
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 all eyes treated for 2 years.
Results:
From April 12, 2023 to December 8, 2025, 77 eyes from 58 patients continued pegcetacoplan treatment for 2 years. Eyes received an average of 18±3 injections with an interval of 1.3 months between injections. For the 72 eyes with 2 years of follow-up and measurable GA, the square-root (sqrt) GA growth rate after pegcetacoplan treatment was 0.22±0.12 mm/year. Of the 72 eyes, 71 eyes either decreased further in their sqrt GA growth rate or remained the same in the second year, while 1 eye had an increase in the sqrt GA growth rate. This eye also received concomitant anti-VEGF therapy due to exudative MNV. Of these 72 eyes, 49 eyes had prior annual visits before treatment. In these eyes, the annual sqrt GA growth rate was 0.33±0.21 mm/year before pegcetacoplan and 0.19±0.11 mm/year after 2 years, resulting in a 41% decrease in the growth rate (p<0.001). There were no significant differences in GA growth rates between foveal and non-foveal GA (all p≥0.99). The mean BCVA declined from 63±14 to 55±16 letters over 2 years (p<0.001), with no significant difference between foveal and non-foveal GA (p=0.14). Positive correlations were found between the sqrt GA growth rates prior to treatment and the percent growth inhibition over both 1 year (r=0.33, p=0.02) and 2 years of treatment (r=0.40, p=0.007).
Conclusions:
Pegcetacoplan therapy reduced the growth rate of GA by about 41% over 2 years and continued to show accumulated efficacy during the second year.
