One-Year Results of Geographic Atrophy Patients with Pre-Existing nAMD treated with both anti-VEGF therapy and pegcetacoplan.

Abstract

To examine geographic atrophy (GA) progression in patients receiving pegcetacoplan injections with pre-existing neovascular age-related macular degeneration (nAMD) treated previously and concurrently with anti-VEGF (vascular endothelial growth factor) injections. Retrospective cohort study of 31 nAMD and co-existing GA patients from March 2023 to July 2025. Inclusion criteria were previous anti-VEGF treatment for ≥1 year and concurrent anti-VEGF and pegcetacoplan treatments in the following year. Subfoveal GA patients were excluded. Spectral-domain optical coherence tomography (OCT), infrared reflectance (IR) data, fundus autofluorescence, and fundus photography were used to measure GA area at five time points: 1 year before pegcetacoplan initiation, then every 6 months until 1 year after pegcetacoplan initiation. Longitudinal change in GA area was analyzed using a linear mixed-effects model (LMM) with square-root transformed GA area to account for repeated measurements within eyes. Visual acuity (VA) was recorded and converted to ETDRS letters for analysis. Twelve patients were male and 19 female, with an average age of 87.2 years. Mean anti-VEGF treatment interval was 11.8 weeks, and 8.1 weeks for pegcetacoplan. Average treatment duration of nAMD was 6.5 years. Square-root transformed GA area increased +0.39 mm from -1 year to pegcetacoplan initiation, then +0.22 mm from initiation to +1 year, a 44% decrease in GA growth rate (p < 0.0001). VA remained stable, starting at 67.5 letters, increasing to 67.9 letters after 2 years (p = 0.93). Concurrent anti-VEGF and pegcetacoplan therapy was associated with an overall reduction in GA lesion growth rate and stabilized nAMD.