Abstract
PURPOSE: To evaluate real-world outcomes in subjects with pre-existing neovascular age-related macular degeneration (AMD) undergoing intravitreal avacincaptad pegol (IVA) treatment for geographic atrophy (GA). METHODS: This study was undertaken as a retrospective, case-controlled assessment of patients undergoing IVA treatment for GA from 2 community-based retina practices. Patients were separated into 1) a Study Group consisting of subjects with pre-existing neovascular AMD prior to initiation of IVA for GA, and 2) a Control Group consisting of AMD subjects without neovascularization prior to initiation of IVA for GA. Study and Control Group subjects had a baseline visual acuity of ≥ 20/200, a total GA lesion area of ≥ 1 mm(2) and ≤ 17.5 mm(2), and follow-up of 12-months following IVA commencement. RESULTS: A total of 64 patients were analyzed. No significant differences in baseline characteristics were found between cohorts. The Study Group had a greater decrease in visual acuity [-0.2 (-0.24 to -0.16) logMAR versus -0.04 (-0.06 to 0.02) logMAR; p<0.0001], a greater increase in GA lesion growth [1.36 (1.09-1.63) mm(2) versus 0.52 (0.34-0.70) mm(2); p<0.0001], and a higher incidence of exudation (p=0.0002) compared to the Control Group during the study period. CONCLUSION: This study suggests that patients undergoing IVA therapy for GA with pre-existing neovascular AMD have worse visual and anatomic outcomes at 12-months compared to a matched control group without pre-existing neovascularization; such patients therefore should be carefully counseled prior to initiation of IVA for the management of GA.