Complement Inhibition in Eyes With Coexisting Geographic Atrophy and Neovascular AMD: Real-World Visual, Anatomic, and Treatment Interval Outcomes

Document Type

Conference Proceeding

Publication Date

6-2026

Publication Title

Investigative Ophthalmology and Visual Science

Abstract

Purpose : Eyes with concurrent geographic atrophy (GA) and neovascular age-related macular degeneration (nAMD) are largely excluded from pivotal trials of complement inhibitors, leaving uncertainty regarding safety and functional outcomes in this population. We conducted a retrospective observational study to evaluate visual, anatomic, and treatment-pattern changes following complement inhibition in eyes with simultaneous GA and nAMD.

Methods : This single-center retrospective series included eyes initiating intravitreal pegcetacoplan or avacincaptad pegol for GA between January 2023 and December 2024 with coexisting nAMD under active anti-VEGF therapy. Clinical records and multimodal imaging were reviewed for demographics, visual acuity (VA), intraocular pressure (IOP), central subfield thickness (CST), anti-VEGF injection intervals, and adverse events. Longitudinal changes over 6 months were analyzed using standard parametric testing.

Results : Of 210 included eyes (133 pegcetacoplan, 77 avacincaptad pegol), mean VA remained stable from baseline to 6 months (0.68 ± 0.57 to 0.73 ± 0.56 logMAR, p > 0.05) and was comparable between treatment groups (mean VA change: pegcetacoplan +0.05 ± 0.2 logMAR; avacincaptad pegol +0.04 ± 0.2 logMAR, p > 0.05). Mean CST showed no significant change over 6 months (247.6 ± 52.0 to 253.6 ± 53.5 µm, p > 0.05) and was comparable between treatment groups (mean CST change: pegcetacoplan +20.7 ± 122.1 µm; avacincaptad pegol +5.7 ± 108.9 µm, p > 0.05). The mean anti-VEGF injection interval increased from 51.5 ± 20.5 to 59.3 ± 24.8 days (p < 0.05). Adverse events occurred in 6 eyes (2.9%): 5 in the pegcetacoplan group (worsening nAMD [n = 4], anaphylaxis [n = 1]) and 1 in the avacincaptad pegol group (intraocular inflammation [n = 1]).

Conclusions : Complement inhibition in eyes with concurrent GA and nAMD was well tolerated and associated with stable VA, stable CST, and modest extension of anti-VEGF treatment intervals over 6 months. These real-world findings provide early evidence supporting the safety and treatment compatibility of complement blockade in a population not represented in phase 3 trials. Further longitudinal and subgroup analyses are underway to refine these findings.

Volume

67

Issue

7

First Page

1846

Comments

Association for Research in Vision and Ophthalmology (ARVO), May 3-7, 2026, Denver, CO

Last Page

1846

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