AAO 2025: A real-world perspective on the use of avacincaptad pegol for geographic atrophy

Durga Borkar, MD, MMCi, an associate professor of ophthalmology at Duke University Eye Center, presented a real-world study examining treatment patterns and outcomes for geographic atrophy (GA) patients using avacincaptad pegol (ACP). The research was shared at the the American Academy of Ophthalmology meeting in Orlando, Floria. The data leverage's the IRIS registry, tracking patients who received their first ACP injection between September 2023 and August 2024.

The study provides critical insights into treatment practices, safety profiles, and patient characteristics in routine clinical care. By comparing real-world data with clinical trial results, Borkar offers valuable perspectives on managing GA, emphasizing the treatment's goal of slowing irreversible vision loss and highlighting potential future advancements in therapeutic approaches.

Note: The following conversation has been lightly edited for clarity.

Ophthalmology Times: What are the key highlights/data points from your poster discussion titled, "Treatment Patterns and Safety of Avacincaptad Pegol in Real-World Patients With GA"?

Durga Borkar, MD, MMCi: The main highlights and data points from this study really focused on understanding real-world practice patterns. A lot of times, things that we see in clinical trials are reflected a little bit differently in routine clinical practice. So the objective of this real-world study was to evaluate patient characteristics, treatment patterns, and adverse event profiles of patients with geographic atrophy treated with avacincaptad pegol, or ACP, in routine clinical care. This study leveraged data from the American Academy of Ophthalmology's IRIS registry to identify patients with a GA who received their first ACP 2 milligram injection between September 1 of 2023 and August 31 of 2024. That corresponds to approximately the first year post FDA approval of ACP. The average follow up time in this study was 25 weeks, and interestingly, despite the large majority of patients presenting with bilateral GA, approximately 69% received treatment in only 1 eye. So a key finding in this study was that the average interval between ACP 2 milligram injections was approximately 7 weeks, and about 23% of patients were treated with concomitant anti-VEGF. However, 90% of these were previously on anti-VEGF treatment prior to initiating ACP treatment. Finally, the data showed low rates of both discontinuation and switching from ACP once patients had started. The other key outcome measure that we looked at was looking at adverse events during follow-up. In our real-world cohort, a little under 4% of patients experienced a treatment emergent adverse event with about 103 AEs per 10,000 ACP, 2 milligram injections. What we see was that neovascular AMD and corotal neovascularization emerged as the most frequently occurring adverse event, where each occurred in fewer than 1% of eyes. From a functional perspective, severe vision loss due to an AE, defined as a loss of 30 letters or more within 150 days of ACP use was documented in a very small proportion of patients following the key AE. So that was really reassuring.

OT: How might these safety data points impact how providers use avacincaptad pegol in their practices?

Borkar: Well, overall, the safety data in this study is really reassuring and echoes the clinical trials in a lot of ways, with very low rates of adverse events. So in particular, there was a low rate of intraocular inflammation, and I'll highlight that only 0.16% of patients had catastrophic vision loss, defined as a loss of 30 letters or more compared to baseline, within 150 days of starting ACP. One other interesting finding was that the rates of choroidal neovascularization were lower than in clinical trials, which is important to know when we're counseling patients. I think one important caveat to that is that in the clinical trials, patients could not have neovascular AMD at baseline, but what we see here is that about a third of patients had neovascular AMD or choroidal neovascularization in the treated eye at baseline, so that likely contributes to the decreased incidence of new CNV conversions after starting ACP. Overall, I think this data is very comparable to what we see in clinical trials, other than the rate of CNV that I mentioned, and it's very helpful when counseling our patients, when starting these medications.

OT: When discussing GA treatment with patients, what are the most important elements to explain or how should providers explain this treatment to their patients?

Borkar: Both options that we have available to us for treating geographic atrophy are still fairly new within their first couple years, so there are still many patients that we're meeting that are good candidates for treatment, and I think it's important to explain to them a few things. One is that the goal of this treatment is really to slow down the progression of irreversible vision loss. And we know that patients with geographic atrophy suffer, have a lot of functional impairment from their disease. So this is important to highlight, but it's also key to note to them so that expectations are realistic, is that this is not going to reverse the disease process. So in that sense, it's good to start treatment early, because this is more of a preventative measure to prevent future progression, rather than something that can reverse. I think that the results of the current study that I mentioned earlier are really helpful for counseling patients about this treatment. Overall, this has a favorable safety profile, and that's been shown both in the trials and then with real-world data. I think lastly, it's important for patients to note that this is an ongoing treatment. Unfortunately, macular degeneration is a chronic disease, so when patients start this treatment, the goal is for them to continue for as long as possible.

OT: Where do you hope the future of GA treatment goes?

Borkar: This is a really important therapeutic area. It's really bustling when we think about what's in the pipeline. What we have currently available to us is a great start, but I do hope for patients that will have more durable treatment options in the future, and potentially even something that could reverse the damage that has been done by this disease. I know that's potentially, a little further away, but that would be wonderful if that was in the future for geographic atrophy patients.