The following transcript has been edited for clarity:
Hi, I’m Diana Do, MD. Welcome to the Retinal Physician video channel. Today I'm joined by Arshad M. Khanani, MD, MA, FASRS, and we’ll be discussing complement inhibitors in the treatment of geographic atrophy. Tell us a little bit about how you approach a patient with geographic atrophy, and are you using compliment inhibitors?
Dr. Khanani: Yes, so I actually participated in both the avacincaptad pegol (Izervay; Astellas) and pegcetacoplan (Syfovre; Apellis Pharmaceuticals) trials and after the FDA approval I do use complement inhibitors in my patients. Obviously, we have to have the efficacy and safety discussion, the treatment burden discussion, as well as where the disease is for that patient. So I am using it. My goal is to start them early, before the formal enrollment starts
Dr. Do: Tell us about the GATHER2 study. Now we have some new long-term data that you'll be presenting.
Dr. Khanani: Yes, thanks for the invite for the retina subday AAO 2025. I'm presenting the first-time open-label extension results of the GATHER2 trial, which was an 18-month study after the 24-month GATHER2 trial. Patients who were treated in GATHER2 had an opportunity to roll over into the open-label extension. As you recall, in the second year of GATHER2, patients either were treated with every month ACP, every other month ACP, or sham. In the open-label extension, everybody received ACP monthly for 18 months.
Dr. Do: We’ve seen through these research studies that treating early, and continuing treatment, increases the benefit. Tell us about that.
Dr. Khanani: That’s totally right. You guessed what the results were. Patients who were treated with ACP—both patients who are [previously] treated with ACP or sham, saw an improvement. We saw 40.5% reduction in GA lesion growth, based on—we didn't have a sham group, so it’s a projected sham. Patients who are in the sham group that were rolled over, we saw reductions of 37.1%. What we saw was, in terms of saving the retinal tissue, the earlier we started [the better]. The patients who started the ACP from the start of the GATHER2 trial and [were] treated for 42 months, they had significant saving of the retinal tissue and reduction of GA growth compared to patients who were rolled over from sham to ACP. So it did help, but the goal here is to start early, before the disease gets too advanced.
Dr. Do: When you’re treating patients, I know the treatment burden—as we discussed—can be challenging because you’re either treating every month or every other month. What have you used with your patients that works?
Dr. Khanani: So that’s a very good question. I think these are elderly patients, sometimes [with] bilateral disease. We don't have ACP data in the first year for every other month—it was given monthly, the FDA label is also monthly—but in the second year, we do have the data on every month and every other month, where we saw similar efficacy. So I know in clinic retina doctors don’t follow the labels all the time, but rather cater to the patients’ need. So if a patient can come every month, that’s great; but if they can come in every 6 to 8 weeks, it’s a good option for that patient.
Dr. Do: Great. Well, thank you for sharing your expertise, Dr. Khanani. Always appreciate it. And thanks for joining Retinal Physician. RP