Geeta Lalwani, MD:

So tell me about how do you talk to patients, Carl, about the risk of CNV? What do you tell them as you're starting out or do you really have that conversation?

Carl Danzig, MD:

I always have that conversation and I let them know that there is a risk of developing wet AMD by treating your GA. I explain to them that we have 20 years of experience of visual gains with wet AMD treatment. We had no treatment up until 2023, which was a landmark year when two products gained FDA approval for GA therapy. I tell them that even if you develop wet AMD, we will work that into our treatment algorithm doing what we can best to help preserve their vision longer.

Geeta Lalwani, MD:

So one of the challenges I find is when you have patients who are receiving both dry and wet treatment is for them to understand what is actually working. So how do you explain how pegcetacoplan is working, Moo?

Murtaza Adam, MD:

It's a difficult thing to highlight, but I kind of make it akin to treating someone's hypertension. If someone has high blood pressure, their risk of heart attack, stroke, devastating functional disease is quite high and that risk is reduced. And so I tell them this medication is like any other drug you would take for any other chronic condition. It reduces the risk of functional vision loss. And you can't fight father time in many cases. That's true for most diseases that we treat. And I emphasize that to expect that things might still get worse over time, but if we didn't do this, they'll probably get worse a lot faster.

Carl Danzig, MD:

I still believe that the biggest gap is educating the referring physician, the optometrist, the ophthalmologist. With that, we can then treat these patients earlier. Too often I am seeing patients that are referred and they already have advanced disease. I have patients referred for cataract clearance for mild AMD and they have bilateral GA and bilateral wet AMD never treated. So we see these patients that could have been helped sooner had we seen them earlier.

Geeta Lalwani, MD:

Yeah. I've actually seen quite a few patients referred for subfoveal GA to help make better. And there's a huge gap in understanding, to your point, to educate referring doctors and that would be both general ophthalmologists as well as optometrists to understand the mechanism of action of these drugs and how we can actually help patients. So you said Moo, that you started pegcetacloplan in the right eye first. Do you always do that?

Murtaza Adam, MD:

I do. I tend to start with the worst seeing eye if we are deciding to treat only one eye, so the better seeing eye. But if a visual potential is good in both eyes, I never really do bilateral therapy, but I'll do the eye with a higher burden of geographic atrophy. Unfortunately, these inflammatory events that have been reported in the real world post-clinical trial release have been rare. But at the end of the day, as a retina specialist and a physician, my duty is to ensure the most safety possible for a patient. Even if there is a potential benefit to a treatment, safety's paramount. So checking for any inflammation pre-injection and watching it post-injection is important before it's deciding on bilateral treatment or starting treatment in a better seeing eye.

Geeta Lalwani, MD:

Now, what about if it was avacincaptad, I'm going to call it ACP for short, pegol. Do you do anything different with that?

Murtaza Adam, MD:

So you make an interesting point. With avacincaptad pegol, you don't see in the real world the same sort of reports of rare retinal vasculitis that you've seen with pegcetacoplan. And so I have a patient that has no other eye. They have a prosthetic in their fellow eye and their only eye has GA. So in that patient, I started avacincaptad pegol. I think both drugs have merit and both drugs have a very good safety profile, but there is a little bit of a delta that is debatable among the retina community. And in this case, I felt it was useful to start with a drug that had less inflammation risk.