New long-term data from pivotal geographic atrophy trials reveals that early initiation of Syfovre (pegcetacoplan) treatment provides superior vision preservation outcomes, while confirming the complement inhibitor's sustained safety profile over four years of therapy.
The findings, presented at the American Society of Retina Specialists meeting in Long Beach, California, come from updated analyses of the OAKS, DERBY, and GALE clinical trials that followed patients over 48 months—comprising two years of randomized controlled treatment followed by two years in the GALE open-label extension.
Early Treatment Demonstrates Clear Advantages
According to Roger A. Goldberg, M.D., MBA, a retina specialist with Bay Area Retina Associates who presented the data, patients who started Syfovre treatment immediately showed markedly better outcomes compared to those who received sham treatment for the first two years before crossing over to active therapy.
"We have a better sense of what the treatment impact is over a 48-month period, and we have it in comparison to the cohort of patients who were initially treated with sham for two years and then got crossed over to treatment," Goldberg explained.
The earlier-treated group demonstrated superior preservation of retinal tissue and enhanced performance on microperimetry testing, which measures visual sensitivity. Patients who delayed treatment for two years showed diminished benefits, indicating that postponing therapy may result in greater irreversible vision loss.
Dosing Frequency Considerations
The updated analysis also examined differences between monthly and every-other-month dosing regimens. While monthly injections provided slightly greater reduction in geographic atrophy lesion growth compared to every-other-month treatment, the advantage may not justify the doubled injection burden.
"I tend to lean towards every-other-month therapy," Goldberg noted. "I think the safety profile looked a little bit better. I think it's more tolerable for patients over long periods of time."
Long-Term Safety Profile Remains Consistent
The GALE extension data reinforces Syfovre's established safety profile, addressing ongoing concerns about intraocular inflammation and wet AMD conversion that have followed the complement C3 inhibitor since its approval for geographic atrophy in age-related macular degeneration.
"The GALE safety tends to mimic the safety that we saw in DERBY and OAKS," Goldberg reported. "So, you know, very low rates of intraocular inflammation, of endophthalmitis—the random case of ischemic optic neuropathy. We're not seeing any acceleration there."
Wet AMD Conversion Rates Remain Stable
A key safety concern has been the potential for geographic atrophy patients to develop wet AMD while on Syfovre therapy. The long-term data shows that conversion rates remain steady over time, staying within single digits annually without evidence of increasing risk with prolonged treatment exposure.
Importantly, when wet AMD does develop in patients already receiving Syfovre, vision outcomes remain stable with appropriate management. Because these patients are under regular monitoring and care, new cases of wet AMD are promptly identified and treated.
"These patients are able to be managed with concurrent anti-VEGF agents and complement inhibitors, and that seems to be stable for their vision," Goldberg shared.
Clinical Implications for Treatment Strategy
The four-year follow-up data provides crucial guidance for clinicians managing geographic atrophy patients. The findings support initiating Syfovre treatment as early as possible in the disease course to maximize vision preservation benefits, while the sustained safety profile over extended treatment periods should reassure both providers and patients about long-term therapy.
The data also suggests that every-other-month dosing may represent an optimal balance between therapeutic efficacy and patient tolerability, potentially improving treatment adherence while maintaining clinical benefits in this chronic condition requiring long-term management.
