Choosing Between the Currently Available GA Therapies
Panelists discuss how they approach therapy selection between the 2 FDA-approved geographic atrophy treatments by comparing pegcetacoplan’s potentially greater efficacy signals with avacincaptad pegol’s superior safety profile, with treatment choice often driven by individual patient factors such as motivation level, monocular status, and willingness to accept risk, while emphasizing that starting monthly dosing provides the best fallback position when patients experience treatment fatigue.
Therapy selection between the 2 FDA-approved geographic atrophy treatments presents a complex clinical decision without clear superiority in either efficacy or safety profiles. Both complement inhibitors have demonstrated similar top-line results in clinical trials, but they have never been tested head-to-head, making direct comparisons challenging. The choice becomes particularly nuanced because clinicians must balance potential efficacy benefits against safety considerations while educating patients about the concept of slowing progression rather than providing a cure. This decision-making process requires careful consideration of individual patient factors, motivation levels, and risk tolerance.
Safety profiles significantly influence treatment selection, with important differences emerging between the 2 options. One therapy has demonstrated fewer inflammatory safety events, providing reassurance for patients and clinicians concerned about complications. However, the other medication, despite having more reported inflammatory and occlusive events, has accumulated more prospective data and longer-term experience, potentially showing signals toward greater efficacy and tissue preservation. For highly motivated patients seeking maximum benefit and willing to accept potentially higher risk, the therapy with suggested superior efficacy may be preferred, whereas patients requiring minimal risk exposure might benefit from the safer alternative.
Treatment initiation strategy emphasizes starting with monthly dosing to maintain therapeutic flexibility. This approach provides a fallback position when patients inevitably experience treatment fatigue due to the moderate efficacy of available therapies. Beginning with less-frequent dosing eliminates future intensification options and may expose patients to injection risks without meaningful benefit. Patient-specific factors such as monocular status, individual preferences, and motivation levels help guide final therapy selection. The discussion emphasizes that although choosing between treatments remains challenging, the critical decision is initiating treatment rather than which specific therapy to select, as both represent significant advances in previously untreatable disease management.
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