Geographic Atrophy Treatment: What Syfovre and Izervay Can and Can't Do
For decades, people with advanced dry AMD were told nothing could be done. Two injections now slow the disease. Here's what to realistically expect.
Quick answer: Geographic atrophy (GA) is the advanced form of dry macular degeneration, where patches of retinal tissue waste away and leave blind spots. Two FDA-approved injections now slow its progression: pegcetacoplan (Syfovre), approved in February 2023, and avacincaptad pegol (Izervay), approved in August 2023. Both block parts of the immune system's complement pathway. In clinical trials, they slowed the growth of GA lesions by roughly 20% to 30%. They don't restore lost vision or stop the disease, and they're given as eye injections every one to two months.
What is geographic atrophy?
In GA, cells in the macula that support vision gradually die. The damaged areas, called lesions, slowly expand over time. As they grow toward the center of the macula, reading, driving, and recognizing faces get harder.
GA progresses more slowly than wet AMD, but it's relentless. Until 2023, there was no approved treatment.
How do Syfovre and Izervay work?
Both medications target the complement system, part of the immune system that appears to contribute to retinal cell damage in GA.
| Syfovre (pegcetacoplan) | Izervay (avacincaptad pegol) | |
|---|---|---|
| FDA approval | February 2023 | August 2023 |
| Target | Complement C3 | Complement C5 |
| Pivotal trials | OAKS and DERBY | GATHER1 and GATHER2 |
| Dosing | Monthly or every other month | Monthly, with options per label |
| Effect | Slows lesion growth | Slows lesion growth |
According to a retina specialist interviewed by HCPLive, both drugs slowed the spread of GA lesions by about 20% to 30%, depending on the study. In the Syfovre trials, the treatment effect grew over time, with the greatest benefit between 18 and 24 months.
What should I realistically expect?
This is the most important part of the conversation. These treatments:
- Slow the disease. They don't stop or reverse it.
- Don't restore vision that has already been lost.
- May not produce a change you can feel. Many patients notice their vision still slowly declines, just more slowly than it would have.
- Work best as a long-term commitment.
What are the risks?
- Standard injection risks, such as irritation, floaters, and rarely infection
- Inflammation inside the eye
- A small increased risk of developing wet AMD, which may need additional treatment
- Rare reports of retinal vasculitis have been associated with Syfovre
Dr. Garg will review the benefits and risks for your situation.
Who is a good candidate?
GA treatment may make sense if your lesions haven't reached the very center of your vision yet, if you have good vision worth protecting, and if you're able to commit to regular injection visits. Some patients reasonably choose to monitor instead. There's no single right answer, and it's a decision you make together.
What else helps with dry AMD?
- AREDS2 vitamins for intermediate AMD
- Not smoking
- Home monitoring with an Amsler grid to catch conversion to wet AMD
- Low vision aids and good lighting
Frequently Asked Questions
Ready to Protect Your Vision?
Schedule a consultation with Dr. Pooja Garg at Retina Eye Specialists today.
Call (954) 633-8202References
- U.S. Food and Drug Administration. SYFOVRE (pegcetacoplan injection) and IZERVAY (avacincaptad pegol) prescribing information.
- HCPLive. New Therapies for Geographic Atrophy (Veeral Sheth, MD).
- Ophthalmology 360. FDA approves Syfovre for geographic atrophy.
- BioPharma Dive. FDA approves Astellas' Izervay for geographic atrophy. August 2023.