Comparison of Fundus Autofluorescence Versus Optical Coherence Tomography-based Evaluation of the Therapeutic Response to Pegcetacoplan in Geographic Atrophy br

PURPOSE: To perform an optical coherence tomogra-phy (OCT)-based analysis of geographic atrophy (GA) progression in patients treated with pegcetacoplan. center dot DESIGN: Post hoc analysis of a phase 2 multicenter, randomized, sham-controlled trial.center dot METHODS: Manual annotation of retinal pigment ep-ithelium (RPE), ellipsoid zone (EZ), and external limiting membrane (ELM) loss was performed on OCT volumes from baseline and month 12 from the phase 2 FILLY trial of intravitreal pegcetacoplan for the treatment of GA sec-ondary to age-related macular degeneration.center dot MAIN OUTCOME MEASURES: Correlation of GA areas measured on fundus autofluorescence and OCT. Differ-ence in square root transformed growth rates of RPE, EZ, and ELM loss between treatment groups (monthly injec-tion [AM], injection every other month [AEOM], and sham [SM]).center dot RESULTS: OCT volumes from 113 eyes of 113 pa-tients (38 AM, 36 AEOM, and 39 SM) were included, resulting in 11 074 B-scans. The median growth of RPE loss was significantly slower in the AM group (0.158 [0.057-0.296]) than the SM group (0.255 [0.188-0.359], P = .014). Importantly, the growth of EZ loss was also significantly slower in the AM group (0.127 [0.041-0.247]) than the SM group (0.232 [0.130-0.349], P = .017). There was no significant difference in the growth of ELM loss between the treatment groups ( P = .114).center dot CONCLUSIONS: OCT imaging provided consistent re-sults for GA growth compared with fundus autofluores-cence. In addition to slower RPE atrophy progression in patients treated with pegcetacoplan, a significant reduction in EZ impairment was also identified by OCT, suggesting the use of OCT as a potentially more sensi-tive monitoring tool in GA therapy. (Am J Ophthalmol 2022;244: 175-182. (c) 2022 Elsevier Inc. All rights re-served.)