Examining Real-World Attrition Among Patients Undergoing Complement Inhibitor Intravitreal Therapy for Geographic Atrophy

Purpose: To identify characteristics of patients with geographic atrophy (GA) who received pegcetacoplan or avacincaptad pegol and discontinued treatment. Methods: Two complementary retrospective cohort studies of a large, geographically and demographically diverse, deidentified database were performed. One analysis assessed baseline characteristics. Eyes with 12 months of data were included in a subsequent analysis of follow-up changes/characteristics. Univariate and multivariate mixed-effects Cox proportional hazard and logistic regression models, respectively, were used to estimate the hazard ratio (HR) and odds ratio (OR) of attrition. Results: A total of 21 914 eyes were identified for the baseline analysis, 14 690 (67%) of which received pegcetacoplan and 7224 (33%) avacincaptad pegol. Mean (±SD) patient age was 82.1 ± 7.85 years. Treatment retention declined between 0 and 12 months. Baseline predictors of attrition were age older than 90 years (HR, 1.26; 95% CI, 1.03-1.55; P = .028), pegcetacoplan treatment (HR, 3.32; 95% CI, 2.92-3.76; P < .001), treated (HR, 1.56; 95% CI, 1.40-1.75; P < .001) and untreated (HR, 1.41; 95% CI, 1.21-1.64; P < .001) neovascular age-related macular degeneration (nAMD), visual acuity of less than 35 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (HR, 1.45; 95% CI, 1.25-1.67; P < .001), and subfoveal GA (HR, 1.15; 95% CI, 1.04-1.27; P = .007). Poor baseline visual acuity remained significant in the adjusted 12-month analysis. Significant predictors included new nAMD (OR, 3.02; 95% CI, 2.35-3.89; P < .001) and a loss of more than 5 ETDRS letters (OR, 1.36; 95% CI, 1.17-1.58; P < .001). nAMD treatment intervals of more than 6 weeks (OR, 0.59; 95% CI, 0.39-0.90; P = .014) and GA treatment intervals of 6 to 8 weeks (OR, 0.56; 95% CI, 0.43-0.74; P < .001) contributed to decreased odds of attrition. Conclusions: Poor baseline vision and development of new nAMD are associated with patient attrition, and the combination of nAMD and GA and treatment burden challenges patient retention.