Treatment Options on Horizon for Geographic Atrophy Give Patients New Hope
Patients with geographic atrophy (GA), which is an advanced form of age related macular degeneration have been basically ignored because of a lack of viable treatments to address the disease. Until now. Later in 2023, two pharmacological agents are expected to receive FDA approval to address GA. This is Mark Dlugoss, senior contributing editor of Ophthalmology 360. And joining me in regarding the diagnosis of GA and those two new drugs is Mark Dunbar, OD. Dr. Dunbar is director of Optometric Services at Bascom Palmer Eye Institute in Miami, Florida.
Dr Mark Dunbar:
It’s great to be here, Mark. Thank you for having me, and I’m looking forward to a great discussion.
Dr. Dunbar, why is the early recognition of GA so important as treatment options are beginning to surface on the horizon?
Dr Mark Dunbar:
When you look at geographic atrophy, which really has been almost the redheaded stepchild in macular degeneration, which we don’t have a treatment for at least as of now, and you’re probably well aware, there’s two treatments that are under review by the FDA that likely will lead to FDA approval sometime within the first half of this year.
So now all of a sudden we’ve got the nuance of geographic atrophy that we’re going to have a treatment for. And really, I don’t think we’ve been geared towards early recognition of GA unless it’s very late. We conjure in our minds the image of geographic atrophy, those big disciform scars that have already affected central fixation or are threatening central fixation. So there’s really a prime target area where I think there’s a lot of work that needs to be done on education of early detection of geographic atrophy, not certainly only by optometry, but the comprehensive ophthalmology community and geographic and retinal specialists as well. So we’ve got to really understand early recognition. When do these patients need to get in to see a retinal specialist for treatment? So I think it’s a really exciting time in the retina community and optometry community as well.
You mentioned two new drugs coming out for the first half of this year. Can you shine some light on those two drugs?
Dr Mark Dunbar:
So again, Apellis has, again, both Apellis and Iveric are two pharmaceutical companies that have drugs that really are geared for treating geographic atrophy. Both drugs work on the complement pathway. One is a C3 inhibitor, one is a C5 inhibitor, and there’s unique differences among those. But the end result is really blocking the end result of complement cascade or complement pathway membrane intact. And so by controlling or regulating the complement pathway, what we’re is we can slow the progression of geographic atrophy. And so both drugs look like they work pretty well. They work by slowing the progression. And the downside is, if you will, the effect over a year, maybe anywhere from 15% slower progression, up to maybe 30% depending on the drug and depending on the circumstances. So the good news–we’re going to have at least a treatment.
Maybe the bad news is it still requires a monthly injection. And really to see a meaningful effect, patients need to be treated for literally up to a year. And then really after a year, you really see the treatment effect in that 18 to 24 months and probably longer. So the Apellis drug, they delayed, they put it in the hands of the FDA, but they wanted the FDA to look at more of that 18 to 24 months to really see that therapeutic treatment effect. And so it’s good and bad, right? It’s good because we finally have a treatment. It’s bad that, again, this is a treatment that is going to require probably a monthly injection. Remember patients with geographic atrophy, many of them that come in are going to have pretty good vision because we’re going to want to try to get this before it really results in central vision being affected.
So here’s a patient with good vision who’s going to have to buy into every single month having an injection where, again, unlike wet AMD, where they’ve noticed blurry vision, they’re a little bit more motivated to follow that treatment regimen. In the geographic atrophy group, we don’t know the answer to that. Obviously, somebody who’s already lost central vision in one eye, they’ve got it in the other. That’s a patient where certainly that would benefit and we’re probably going to be able to win that patient over, if you will, on the fact that they need that treatment. But again, I think that’s work. Retinal specialists are going to have to teach us. We’re going to have to treat the rank and file of both ophthalmology and optometry. But again, I think the exciting message for the first time, we will have treatments for a disease that we’ve really not had a treatment for.
We’ve all sat, whether you’re an OD or a retinal specialist or a comprehensive ophthalmologist, we’ve all watched helplessly as this is a disease that is slowly progressed and robbed our patients of really central vision and as you know, rob them of their independence. Even though these drugs aren’t approved, I’ve already started to let my patients know about it. I had one today who lost central vision in one eye. She’s got it in the other. We’re going to have a treatment, so I referred her to a retinal specialist because I want her to be connected so when these drugs get approved, she’s already going to be ready. And of course, she knows what happened in her one eye. She’s like, “Sooner the better, let me get to see a retinal specialist.” And so I think that’s exciting to give patients hope that there is a treatment.
Transcript edited for clarity.