How have treatment options for geographic atrophy made an impact on the field?
Priya Vakharia, MD, a retina specialist at Retina Vitreous Associates of Florida in Tampa, Florida, talks about the current state of geographic atrophy treatment options.
Question:
Can you give an overview of the current state of geographic atrophy?
Priya Vakharia, MD:
Geographic atrophy is a form of dry macular degeneration, and it’s a form of progressive atrophy that happens over time, where you get loss of the retinal pigment epithelium and choriocapillaris, and you get this kind of progressive atrophy that develops. This is a leading cause of vision loss in the United States, and has been very difficult to treat. Patients with geographic atrophy historically have lost vision over time, and all we’ve been able to tell them is that there’s nothing that you can really do, that you’re losing your vision and you may lose the ability to read and you may lose the ability to drive and pay your bills, but there’s nothing we can do.
Historically, it’s been a very difficult condition to treat, and even today, it’s very frustrating for patients when they’re diagnosed with geographic atrophy and we tell them that the condition is going to progress.
Question:
In the past year, new treatment options have become available for patients with GA. Can you talk about the treatment options?
Priya Vakharia, MD:
There have been 2 treatment options that were FDA approved in 2023, and these drugs represent a turning point in the treatment of geographic atrophy. Because up until now there were no treatments. This is huge, and I don’t want to understate how incredible this moment is, that we have some treatments for the treatment of geographic atrophy. There are 2 FDA-approved treatments, both are given via intravitreal injection; there’s pegcetacoplan and there’s avacincaptad pegol. These 2 drugs represent, again, the first treatments for the treatment of geographic atrophy, both given via intravitreal injection either monthly or every other month.
Question:
What has been your experience with these treatments in clinic?
Priya Vakharia, MD:
I think both agents are given via a method of delivery that we’re very familiar with. Retina specialists are very familiar with intravitreal injection. We do them all the time, and so that method of delivery is easy. I think that the challenge around using these medications comes with deciding who should get the medications, and having that conversation with the patients so that they understand what they’re signing up for.
One of the most important things is it’s important for patients to understand that they’re not getting injections for wet macular degeneration, because sometimes patients think they are and then they’re disappointed that their vision is not getting better, like their neighbor or their friend who’s getting injections for wet macular degeneration and experiencing improved visual acuity. It’s really important to talk to patients about these drugs and that they’re just slowing progression of geographic atrophy, and they do require continuous injections in order to get that effect.
I think the biggest thing that patients say is they’re just so hopeful that these drugs are going to do something to slow progression. Because there is no alternative. There’s nothing else out there. We do tell them to take AREDS2 vitamins, but there are no other therapies for geographic atrophy. I think patients are very hopeful that these drugs are going to help them. I think in terms of the injection procedure, generally every time you put a needle in the eye, there is a little bit of discomfort, as you can imagine, and post-injection discomfort, but generally they’re well tolerated. Again, it is a treatment burden. Again, it’s something very important to talk to the patients about. But these patients sometimes are patients who just really want to come in and get these injections. They don’t like to miss injections because again, they really want to do anything that they can to prevent progression of geographic atrophy.
A lot of times patients have seen their parents or their siblings or other people lose vision from this, or they’ve already lost vision in one of their eyes, and so they’re very motivated to come in and get these treatments. When we talk about these drugs, the most important thing to talk to your patients about is safety. Every time you put a needle in the eye, bad things can happen. Important to counsel them on those risks such as infection. Very important also to talk about the risks with the specific drugs, specifically small risk of retinal vasculitis with pegcetacoplan. That rate is about 1 in 10,000 overall, or since it’s a first injection phenomenon, about one in 4,000 to 5,000 per first injection. Also to talk about the risk of inflammation and non-arteritic ischemic optic neuropathy seen mostly with pegcetacoplan. Avacincaptad pegol seems to be safer. There have been no on-label cases of retinal vasculitis. There was one off-label case in a patient who received avacincaptad pegol for Stargardt’s disease and also had received pegcetacoplan, but so far, no on-label cases of retinal vasculitis and very few cases of intraocular inflammation.
It’s very important to talk about safety of these drugs, again, and counsel your patients so that they’re aware of the risks of the drugs, and also aware of the need to continue getting the injections over time in order to get that maximal treatment effect. It’s also very, very important when you’re talking about safety, to remind them that they will still have progression of their geographic atrophy. The goal of these drugs is to slow progression and not stop progression.
Question:
What is your outlook for the future of GA management?
Priya Vakharia, MD:
I think as with all people, I think we’re hoping that we have agents that are as efficacious and safe as possible, that has the easiest mechanism of delivery. That’s the pie in the sky. Let’s be able to treat everyone early and have them have great visual outcomes, and not just slow progression, but stop progression. We’re not there quite yet, but we’re working on it. I think that these therapies, like we talked about, represent the first therapies of their kind, which is huge. I think over time things will continue to get better and better.
In closing, the one thing that I like to tell patients and like to remind them is that these drugs are here. They are FDA approved, they’re available, and they may help. I encourage retina providers or other specialists out there to talk to patients about this. Not everybody is going to be a candidate for anti-complement therapy, but patients deserve to know that there is a treatment option. This is something that a lot of patients are very hopeful for and would love to receive to try to slow progression of their geographic atrophy.
This content is independent editorial sponsored by Astellas. Astellas had no input in the development of this content.
