Incidence of Recurrent Choroidal Neovascularization Following Treatment with Pegcetacoplan for Geographic Atrophy in Exudative Age-Related Macular Degeneration Patients with Inactive Choroidal Neovascularization

Purpose: To evaluate exudative age-related macular degeneration (AMD) patients with inactive choroidal neovascularization (CNV), pegcetacoplan treated geographic atrophy (GA) and on pro re nata (PRN) anti-Vascular Endothelial Growth Factor (VEGF) rates of CNV recurrence.

Methods: This retrospective cohort study from 2019 to 2024 included 43 exudative AMD patients with co-existing GA who received pegcetacoplan treatment and 58 control patients with exudative AMD and co-existing GA who were not treated with pegcetacoplan, all maintained on PRN anti-VEGF regimens with inactive CNV not requiring treatment for ≥6 months. The primary outcome measures was the incidence rate of recurrent CNV, defined as reactivation of CNV lesions requiring anti-VEGF treatment. Statistical analyses compared outcomes between groups.

Results: Over 13 months, the 23 pegcetacoplan patients (53%, 95% CI 39-68%) experienced recurrent CNV with an incidence rate of 1.23 (95% CI 0.73-1.73) recurrences/person-year. The 29 control patients (50%, 95% CI 37-63%) experienced recurrent CNV over 5 years, with an incidence rate of 0.21 (95% CI 0.11-0.31) recurrences/person-year. The incidence rate ratio for recurrence was 5.891 (p=0.003) for the pegcetacoplan group compared to the control.

Conclusions: This study found a significantly increased incidence of recurrent CNV in exudative AMD with inactive CNV patients on PRN anti-VEGF after pegcetacoplan treatment for GA. Findings suggest a potential relative contraindication to pegcetacoplan use and CNV reactivation. A similar proportion of patients in the control group experienced reactivation, but the pegcetacoplan group experienced recurrences over a much shorter time. Close monitoring for recurrent CNV is advised when using pegcetacoplan in this population.

Keywords: Choroidal Neovascularization, Pegcetacoplan, Geographic Atrophy, Exudative Age-Related Macular Degeneration, Recurrence, Inactive, Anti-VEGF.