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 coexisting GA who received pegcetacoplan treatment and 58 control patients with exudative AMD and coexisting 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.