Clinical Scorecard: Who Stops GA Therapy—and Why

At a Glance

Key Highlights

• Baseline coexisting neovascular AMD and poor initial visual acuity are significantly linked to early discontinuation of GA complement inhibitor therapy.
• Discontinuation rates increase over time regardless of the complement inhibitor agent used, with significant attrition observed over 18 months.
• Cox multivariate analysis identified baseline clinical factors predictive of treatment discontinuation, highlighting challenges in maintaining long-term adherence.

Guideline-Based Recommendations

Diagnosis

• Confirm GA secondary to AMD with documented visual acuity and retinal imaging.
• Assess for coexisting neovascular AMD and foveal involvement at baseline.

Management

• Initiate FDA-approved intravitreal complement inhibitor therapy (pegcetacoplan or avacincaptad pegol) for eligible GA patients.
• Consider patient baseline characteristics such as visual acuity and presence of neovascular AMD when planning treatment.

Monitoring & Follow-up

• Regular follow-up visits to assess treatment adherence and visual acuity changes.
• Monitor for treatment gaps exceeding 120 days as an indicator of discontinuation.

Risks

• Potential for treatment discontinuation increases with time on therapy.
• Baseline poor vision and coexisting wet AMD may predispose to early therapy cessation.

Patient & Prescribing Data

15,002 patients with 20,671 eyes treated for GA, majority female, mean age 82.1 years

68% treated with pegcetacoplan and 32% with avacincaptad pegol; discontinuation rates rise over time irrespective of agent used.

Clinical Best Practices

• Evaluate baseline visual acuity and presence of neovascular AMD to identify patients at higher risk for discontinuation.
• Educate patients on the importance of adherence to intravitreal complement inhibitor therapy despite potential treatment fatigue.
• Plan for longitudinal monitoring to identify and address causes of discontinuation including disease progression and adverse events.

References

• 2025 Retina World Congress Presentation by Deepak Sambhara, MD, FASRS
• Vestrum Health Database Analysis on GA Treatment Adherence