WIO 2023: The current landscape of geographic atrophy


Sruthi Arepalli, MD, spoke with our team about the current landscape of geographic atrophy (GA) and her presentation at the Women in Ophthalmology Summer Symposium being held in Marco Island, Florida.

Sruthi Arepalli, MD, spoke with our team about the current landscape of geographic atrophy (GA) and her presentation at the Women in Ophthalmology Summer Symposium being held in Marco Island, Florida.

Video Transcript

Editor's note - This transcript has been edited for clarity.

Sheryl Stevenson: We're joined today by Dr. Sruthi Arepalli, who is presenting at this year's WIO—or Women in Ophthalmology—conference.

Welcome to you, doctor. We're so delighted to hear your presentation this year. And obviously, there's so much going on in the area of geographic atrophy. Could you tell us what's new on the horizon?

Sruthi Arepalli, MD: Absolutely. And thanks so much for having me. So now is a really hot topic and a really interesting time to be practicing retina. There's a couple of new treatments that have recently entered the field for the treatment of dry AMD. As we all know, dry AMD has traditionally been a disease that we've watched and unfortunately watch patients lose vision with while we've had a lot of tools in our arsenal for wet AMD treatments. But what's new in the last year or so is that we have these drugs that can act on the complement cascade that we believe is involved in the progression of macular degeneration, and particularly geographic atrophy.

And so the first drug to be approved is a drug called Syfovre. It's produced by Apellis, and its generic name is pegcetacoplan. And it acts on a certain level of the complement cascade at the level of C3, which is involved in this feedback loop of increasing inflammation. And it was tested in a Phase 2 [clinical] trial called FILLY, which had positive results. It showed that there was a slow in growth of geographic atrophy lesions for patients. And then it was retested in two Phase 3 trials, which were called OAKS and DERBY. And they also show that geographic atrophy slowed and that patients maintained better vision.

Now, what's interesting about these trials is that patients were tried on two different regimens, so there was every month and every other month. And what's interesting about these trials is that the benefits are really close between the two different groups, while the adverse events are lower in the group that was treated with every other month, which might point practitioners towards using them every other month as opposed to every month. And most recently, some of the data has come out showing that maybe there's some sort of inflammatory component to these drugs as well, which happens in a lot of drugs that are new to market. And so a couple adverse events have been reported, particularly uveitis or occlusive vasculitis. And so various retina groups are asking for us to report these events as they occur. But overall, the drug has had nice success in its clinical trials.

And then on top of that, most recently, Iveric Bio has had their medication that's been approved, which is called avacincaptad pegol, which is another type of medication that acts on the complement cascade. And this has also been tried in two trials, GATHER1 and GATHER2, which showed that there was a slowing in the progression of geographic atrophy in patients who had dry AMD, and they felt that vision was preserved for longer in those patients as well. It'll be really interesting to see how these drugs kind of pan out in the real world.

Stevenson: Certainly an interesting time to be in retina and ophthalmology. Is there anything else that you'd like to add regarding your presentation that we haven't touched upon?

Arepalli: I think what's going to be interesting to see is how these results shake out in the real world—particularly because [in] the clinical trials you have such good adherence to the medication. We all know patients with AMD and particularly dry AMD...I see a lot of my patients lose motivation to follow up after a certain point. It'll be interesting to see if patients [who] are coming in regularly for injections have the same results. Then also, of course, the safety concerns that have been raised with Apellis' drug and I'm sure there'll be other drugs that come to market that have safety concerns as well. So it'll be interesting to see how those shake out, too.

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