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I consider avacincaptad pegol (Izervay, Astellas) treatment in patients with geographic atrophy secondary to advanced dry macular degeneration with parafoveal and extrafoveal lesions that have demonstrated progression with autofluorescence (AF) imaging. Typically, I identify appropriate patients early, before vision-threatening scotomas develop, and monitor them closely with AF imaging every 3 to 6 months, depending on lesion characteristics, status of fellow eye, presence of subretinal drusenoid deposits, and other factors. Progression in some patients may be rapid and could result in difficulty with everyday tasks, such as reading and driving. Overall, progression affects patients’ ability to function independently and leads to irreversible vision loss.¹

When I detect progression of geographic atrophy with serial AF testing, I review the findings with patients and their caregivers. We discuss the role of avacincaptad pegol in modulating the disease course, and I describe my expectations with treatment, taking care to explain that regular treatment will not halt progression; it can only slow it. I briefly explain the GATHER 1 and GATHER 2 clinical trials, which showed not only that benefits were noted within 6 months of initiating treatment, but also that treatment effects are enhanced over time.¹ I also review potential risks and side effects with avacincaptad pegol treatment, particularly the increased risk of choroidal neovascularization.² At the end of the visit, I provide patient-centered educational material to reinforce salient points.

Having a thorough conversation with patients and caregivers is essential before initiating therapy. Geographic atrophy treatment is unlike other retinal interventions because it works by slowing the disease rather than by halting it. The treatment does not improve vision and does not have a measurable therapeutic benefit. Therefore, engaging patients and setting expectations for future visits helps to build trust and encourages compliance with the treatment protocol.

Ketan G. Laud, MD is a founding partner at NY Retina located on Long Island, New York.

Reference(s):

1. Jaffe GJ, Westby K, Csaky KG, et al. C5 inhibitor avacincaptad pegol for geographic atrophy due to age-related macular degeneration: a randomized pivotal phase 2/3 trial. Ophthalmology. 2021 Apr;128(4):576-586. doi:10.1016/j.ophtha.2020.08.027
2. Khanani AM, Patel SS, Staurenghi G, et al. Efficacy and safety of avacincaptad pegol in patients with geographic atrophy (GATHER2): 12-month results from a randomised, double-masked, phase 3 trial. Lancet. 2023 Oct;402(10411):1449-1458. doi: 10.1016/S0140-6736(23)01583-0