The drug pegcetacoplan slowed the growth of geographic atrophy (GA) over up to 5 years, and patients who started treatment earlier preserved more retina than those who started later, according to an abstract presented at the European Society of Retina Specialists (EURETINA) 2026 in Vienna, Austria.

Researchers presented pooled data from OAKS and DERBY, 2-year, randomized phase 3 trials, and from GALE, a 3-year open-label extension study of pegcetacoplan (Syfovre), an intravitreal injection to treat GA secondary to age-related macular degeneration in adults.

An early treatment group got pegcetacoplan from the start, and a delayed treatment group got a sham treatment for 2 years before crossing over to the active drug.

Among patients with non-subfoveal GA, early vs delayed treatment preserved 3.9 mm² vs 1.9 mm² of retinal tissue, which the researchers estimated would represent 16.5-18.5 months of delayed disease progression over 5 years.

“On average, patients will lose around a disc area of macular tissue per year. If we can help protect that vision, that’s really helpful,” said Sunir Garg, MD, chief of the retina service at Wills Eye Hospital in Philadelphia.

Data from GALE suggested slowed growth of lesions. In the overall study population, those who were dosed monthly showed 27% slower growth, while those dosed every other month experienced 26% slower growth than a projected rate with the sham injections. Among those with non-subfoveal lesions, growth was 33% and 30% slower for monthly and every-other-month dosing, respectively.

“That’s roughly going to buy them another 18-ish months of vision in the center that they might not have had,” said Garg, who helped conduct the study.

“One of the more important findings is that earlier treatment was associated with greater preservation of retinal tissue than delayed treatment, particularly in non-subfoveal GA. Once retinal tissue is lost from GA, we currently cannot restore it,” said Sharon Fekrat, MD, professor of ophthalmology, neurology, and surgery at Duke University School of Medicine in Durham, North Carolina. Fekrat was not involved in the study.

Collectively, the results strengthen the case for starting treatment earlier, but more research is needed to understand whether the drug is appropriate for an individual patient and whether it can preserve vision long term, said Jordan D. Deaner, MD, of the uveitis and vitreoretinal surgery service at Wills Eye Hospital.

“Preserving anatomic retina should help preserve function over time, but slower lesion growth has not yet translated into a clear improvement in traditional measures of visual acuity,” said Deaner, who was not involved in the study.

“My major clinical takeaway from this abstract is that the benefit appears to accumulate over time and that treatment cannot recover retina that has already been lost,” Deaner said. The evidence supports talking to patients about starting therapy earlier, especially before the lesion reaches the foveal center, he said.

“That being said, in my hands, treatment should be individualized to the person and the eyes in front of me. GA is a slowly progressive disease, and our current treatments slow progression rather than stop it or restore vision,” Deaner added.

The safety of pegcetacoplan was consistent with earlier studies. No cases of retinal vasculitis were reported.

“The safety of the drug looks pretty good,” Garg said. “There were a lot of concerns early on about inflammation with this drug, and it still is a concern. But we’ve done now over a million shots of this drug, and those really bad cases of vasculitis have gone down year over year, and the risk is no greater than the risk of infection with a needle poke.”

Deaner said that it may be difficult for patients to adhere to the treatment regimen used in the clinical trials. The patients who develop GA tend to be older, have bilateral disease, experience transportation challenges, and face more than one eye-related health problem, he said. Under these circumstances, such a regimen can become “grueling.”

“Monthly or every-other-month injections over many years are a meaningful treatment burden, particularly for older patients and for those with bilateral disease requiring treatment,” Fekrat said. “In the real world, the decision has to be individualized.”

The new results also offered a glimpse at the difference between once-monthly compared with every-other-month dosing, showing only a modest difference between the two groups.

“Every other month works about as well as every month with half the amount of work, half the amount of cost, half the amount of effort, and half the amount of risk of infection,” Garg said. “Getting an injection in your eye is never as fun as getting ice cream.” But he said that in his experience, every-other-month injections are “realistic.”

“For my practice, for the substantial portion of patients, I’m doing every other month,” Garg said.

Deaner added, “Many of my patients are extremely motivated to preserve their eye health, and I’m here for them. In day-to-day practice, I think the every-other-month regimen is likely more practical for many patients, particularly because its anatomic benefit in this analysis was quite close to that of monthly treatment.”

“My patients hear me say it time and time again, ‘life is about balance,’ and I try to have an informed discussion with each patient about the value of slowing the disease weighed against the burden and risks of frequent injections and office visits,” Deaner said.

“It is important that patients understand what the treatment does and does not do. It slows progression; it does not stop or reverse geographic atrophy, and the potential benefit needs to be weighed against the burden and risks of ongoing injections for months and years,” Fekrat said.

Garg reported serving as a consultant for Apellis Pharmaceuticals and Astellas Pharma. Deaner reported serving on the advisory board of AbbVie, Apellis, and EyePoint, and as a consultant for ANI, Bausch + Lomb, Genentech, and Regeneron.

Fekrat reported financial relationships with companies including Amgen, Bausch Surgical, Ocular Therapeutics, and Teladoc.

Sony Salzman is an Emmy Award-winning journalist covering science and medicine with bylines in The Atlantic, STAT News, NBC, MedPage Today, and The Boston Globe. Previously, she worked as the coordinating producer of ABC’s Medical Unit.