Geographic Atrophy
Conditions
Brief summary
This is a 24-month, Phase III, multicenter, randomized, double-masked, sham-injection controlled study to assess the efficacy and safety of multiple IVT injections of APL-2 in subjects with GA secondary to AMD.
Interventions
Complement (C3) Inhibitor
Subjects will receive a Sham procedure every month
Sponsors
Study design
Eligibility
Inclusion criteria
The study eye must meet all inclusion criteria. If both eyes meet the inclusion criteria, the eye with the worst visual acuity at the screening visit will be designated as the study eye. If both eyes have the same visual acuity, the right eye will be selected as the study eye. Ocular- specific inclusion criteria apply to the study eye only, unless otherwise specified. * Age ≥ 60 years. * Normal Luminance best corrected visual acuity of 24 letters or better using Early Treatment Diabetic Retinopathy Study (ETDRS) charts (approximately 20/320 Snellen equivalent). * Clinical diagnosis of GA of the macula secondary to AMD as determined by the Investigator and confirmed by the Reading Center. * The GA lesion must meet the following criteria as determined by the central reading center's assessment of Fundus Autofluorescence (FAF) imaging at screening: * Total GA area must be ≥ 2.5 and ≤ 17.5 mm2 (1 and 7 disk areas \[DA\] respectively) * If GA is multifocal, at least one focal lesion must be ≥ 1.25 mm2 (0.5 DA), with the overall aggregate area of GA as specified above in 4a. * The entire GA lesion must be completely visualized on the macula centered image and must be able to be imaged in its entirety and not contiguous with any areas of peripapillary atrophy. * Presence of any pattern of hyperautofluorescence in the junctional zone of GA. Absence of hyperautofluorescence (i.e. pattern = none) is exclusionary. * Adequate clarity of ocular media, adequate pupillary dilation, and fixation to permit the collection of good quality images as determined by the Investigator. * Female subjects must be: * Women of non-child-bearing potential (WONCBP), or * Women of child-bearing potential (WOCBP) with a negative serum pregnancy test at screening and must agree to use protocol defined methods of contraception for the duration of the study and refrain from breastfeeding for the duration of the study. * Males with female partners of child-bearing potential must agree to use protocol defined methods of contraception and agree to refrain from donating sperm for the duration of the study. * Willing and able to give informed consent and to comply with the study procedures and assessments.
Exclusion criteria
Ocular specific
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Least Squares (LS) Mean Change From Baseline in Total Area of GA Lesions in the Study Eye at Month 12 | Baseline (screening) and Month 12 | The GA lesion area was measured by a quantified central reading center based on FAF images. LS mean was calculated using a mixed effect model for repeated measure (MMRM) model. Baseline was defined as the last available, non-missing observation prior to first study drug administration. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| LS Mean Change From Baseline in the Total Area of GA Lesions in the Study Eye at Month 24 | Baseline (screening) and Month 24 | The GA lesion area was measured by a quantified central reading center based on FAF images. LS mean was calculated using a MMRM model. Baseline was defined as the last available, non-missing observation prior to first study drug administration. |
| Mean Change in Total Area of GA Lesions in the Study Eye Through Month 24 | From Baseline (screening) through Month 24 | The mean change in GA lesion area through Month 24 was measured by assuming a piecewise linear trend in time with knots by FAF images at Months 6, 12, and 18 and was calculated using a MMRM model. Baseline was defined as the last available, non-missing observation prior to first study drug administration. |
| LS Mean Change From Baseline in Monocular Maximum Reading Speed of the Study Eye at Month 24 | Baseline (screening) and Month 24 | The maximum reading speed of the study eye was calculated per Minnesota Low-Vision Reading Test (MNREAD) or Radner Reading Charts user manuals, with no adjustment for reading inaccuracy. An additional step to cap resulting reading speed values at a maximum of 300 words per minute (wpm) was implemented. Maximum reading speed was calculated as the mean of the 3 highest non-zero reading speeds (or 2, or 1 value, as available), except when all wpm were calculated as 0 then the maximum reading speed was calculated as 0. LS mean was calculated using a MMRM model. Baseline was defined as the last available, non-missing observation prior to first study drug administration. |
| LS Mean Change From Baseline in Mean Functional Reading Independence (FRI) Index Score at Month 24 | Baseline (screening) and Month 24 | The FRI was an interviewer-administered questionnaire with 7 items on functional reading activities most relevant to GA AMD subjects. It had 1 total index score. For each FRI Index reading activity performed in the past 7 days, subjects were asked about the extent to which they required assistance beyond eyeglasses/contact lenses, including the use of low-vision aids, adjustments in the activity, or help from another subject. Mean FRI Index scores ranged from 1 (unable to do independently) to 4 (totally independent), with higher scores indicating higher functional reading independence. A negative change from baseline indicated a decrease in the FRI; disease worsening. LS mean was calculated using a MMRM model. Baseline was defined as the last available, non-missing observation prior to first study drug administration. |
| LS Mean Change From Baseline in Normal-Luminance Best-Corrected Visual Acuity (NL-BCVA) Score of the Study Eye at Month 24 | Baseline (screening) and Month 24 | The NL-BCVA was assessed by early treatment diabetic retinopathy study (ETDRS) chart prior to dilating the eyes at a starting distance of 4 meters and ranged from 0 (least score) to 100 (best score). If the 4-meter score was \>19 letters read correctly, the visual acuity score was the sum of total letters correctly read at 4 meters plus the addition of 30. If the 4-meter score was ≤19 letters read correctly, the visual acuity score was the sum of total letters read correctly at 4 meters and total letters read correctly at the 1-meter distance. If no letters were read correctly at either the 4-meter distance or the 1-meter distance, the visual acuity score was 0. A positive change in the value indicated improvement in visual acuity. LS mean was calculated using a MMRM model. Baseline was defined as the last available, non-missing observation prior to first study drug administration. |
Countries
Argentina, Australia, Brazil, Canada, Czechia, France, Germany, Israel, Italy, New Zealand, Poland, Puerto Rico, Spain, United Kingdom, United States
Participant flow
Recruitment details
This Phase III, randomized, double-masked, sham injection-controlled study was conducted in subjects with geographic atrophy (GA) secondary to age-related macular degeneration (AMD) at 122 sites in 14 countries between 31 Aug 2018 and 20 Jun 2022.
Pre-assignment details
This study consisted of a screening period (up to 30 days), a randomization visit on Day 1, and a treatment period (up to 24 months). Subjects were randomized in a 2:2:1:1 ratio on Day 1 to receive treatment with pegcetacoplan monthly, pegcetacoplan every other month (EOM), sham injection monthly or sham injection EOM, respectively. A total of 621 subjects were randomized in this study.
Participants by arm
| Arm | Count |
|---|---|
| Pegcetacoplan Monthly Subjects received IVT injections of pegcetacoplan 15 mg/0.1 mL once monthly for 24 months. | 206 |
| Pegcetacoplan EOM Subjects received IVT injections of pegcetacoplan 15 mg/0.1 mL EOM for 24 months. | 208 |
| Sham Pooled Sham Monthly: Subjects received sham injections once monthly for 24 months.
Sham EOM: Subjects received sham injections EOM for 24 months.
The procedure for sham injection was the same as that used for IVT injection until the actual injection but no actual injection occurred. | 207 |
| Total | 621 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Adverse Event | 9 | 6 | 5 | 3 |
| Overall Study | Consent withdrawal | 36 | 20 | 6 | 13 |
| Overall Study | Death | 7 | 6 | 4 | 3 |
| Overall Study | Due to Coronavirus Disease-2019 (COVID-19) impact | 4 | 10 | 3 | 3 |
| Overall Study | Lost to Follow-up | 2 | 4 | 4 | 0 |
| Overall Study | Other | 0 | 1 | 0 | 0 |
| Overall Study | Physician Decision | 1 | 0 | 2 | 0 |
Baseline characteristics
| Characteristic | Pegcetacoplan Monthly | Pegcetacoplan EOM | Sham Pooled | Total |
|---|---|---|---|---|
| Age, Continuous | 78.8 years STANDARD_DEVIATION 6.91 | 79.2 years STANDARD_DEVIATION 7.06 | 78.5 years STANDARD_DEVIATION 7.24 | 78.8 years STANDARD_DEVIATION 7.07 |
| GA Lesion Size (fundus autofluorescence [FAF]) in the Study Eye | 8.3606 Millimeter square (mm^2) STANDARD_DEVIATION 4.16892 | 8.2076 Millimeter square (mm^2) STANDARD_DEVIATION 3.91213 | 8.2572 Millimeter square (mm^2) STANDARD_DEVIATION 4.21864 | 8.2749 Millimeter square (mm^2) STANDARD_DEVIATION 4.09557 |
| Race/Ethnicity, Customized Asian | 0 Participants | 1 Participants | 0 Participants | 1 Participants |
| Race/Ethnicity, Customized Black or African American | 1 Participants | 1 Participants | 0 Participants | 2 Participants |
| Race/Ethnicity, Customized Hispanic or Latino | 32 Participants | 37 Participants | 29 Participants | 98 Participants |
| Race/Ethnicity, Customized Multiple | 0 Participants | 1 Participants | 0 Participants | 1 Participants |
| Race/Ethnicity, Customized Not Hispanic or Latino | 163 Participants | 155 Participants | 172 Participants | 490 Participants |
| Race/Ethnicity, Customized Not reported | 12 Participants | 11 Participants | 6 Participants | 29 Participants |
| Race/Ethnicity, Customized Not Reported | 10 Participants | 12 Participants | 6 Participants | 28 Participants |
| Race/Ethnicity, Customized Unknown | 1 Participants | 4 Participants | 0 Participants | 5 Participants |
| Race/Ethnicity, Customized White | 192 Participants | 192 Participants | 200 Participants | 584 Participants |
| Region of Enrollment Argentina | 18 Participants | 24 Participants | 18 Participants | 60 Participants |
| Region of Enrollment Australia | 3 Participants | 1 Participants | 4 Participants | 8 Participants |
| Region of Enrollment Brazil | 9 Participants | 13 Participants | 10 Participants | 32 Participants |
| Region of Enrollment Canada | 2 Participants | 1 Participants | 4 Participants | 7 Participants |
| Region of Enrollment Czechia | 2 Participants | 7 Participants | 5 Participants | 14 Participants |
| Region of Enrollment France | 12 Participants | 14 Participants | 7 Participants | 33 Participants |
| Region of Enrollment Germany | 3 Participants | 4 Participants | 11 Participants | 18 Participants |
| Region of Enrollment Israel | 0 Participants | 4 Participants | 2 Participants | 6 Participants |
| Region of Enrollment Italy | 2 Participants | 1 Participants | 0 Participants | 3 Participants |
| Region of Enrollment New Zealand | 1 Participants | 0 Participants | 0 Participants | 1 Participants |
| Region of Enrollment Poland | 2 Participants | 7 Participants | 6 Participants | 15 Participants |
| Region of Enrollment Spain | 1 Participants | 0 Participants | 2 Participants | 3 Participants |
| Region of Enrollment United Kingdom | 5 Participants | 6 Participants | 10 Participants | 21 Participants |
| Region of Enrollment United States | 146 Participants | 126 Participants | 128 Participants | 400 Participants |
| Sex: Female, Male Female | 121 Participants | 126 Participants | 132 Participants | 379 Participants |
| Sex: Female, Male Male | 85 Participants | 82 Participants | 75 Participants | 242 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk | EG006 affected / at risk | EG007 affected / at risk | EG008 affected / at risk |
|---|---|---|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 206 | 0 / 208 | 0 / 206 | 0 / 206 | 0 / 208 | 0 / 206 | 8 / 206 | 6 / 208 | 8 / 206 |
| other Total, other adverse events | 113 / 206 | 82 / 208 | 61 / 206 | 35 / 206 | 34 / 208 | 29 / 206 | 90 / 206 | 70 / 208 | 101 / 206 |
| serious Total, serious adverse events | 4 / 206 | 2 / 208 | 2 / 206 | 1 / 206 | 1 / 208 | 0 / 206 | 61 / 206 | 47 / 208 | 53 / 206 |
Outcome results
Least Squares (LS) Mean Change From Baseline in Total Area of GA Lesions in the Study Eye at Month 12
The GA lesion area was measured by a quantified central reading center based on FAF images. LS mean was calculated using a mixed effect model for repeated measure (MMRM) model. Baseline was defined as the last available, non-missing observation prior to first study drug administration.
Time frame: Baseline (screening) and Month 12
Population: The modified ITT (mITT) analysis set consisted of all subjects assigned to treatment who received at least 1 injection of pegcetacoplan or sham and had baseline and at least 1 post-baseline value of GA lesion area in the study eye as assessed by FAF. Subjects with a baseline and at least 1 post-baseline value of the outcome at a scheduled visit by Month 12 were included in the analysis.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Pegcetacoplan Monthly | Least Squares (LS) Mean Change From Baseline in Total Area of GA Lesions in the Study Eye at Month 12 | 1.7344 mm^2 | Standard Error 0.07924 |
| Pegcetacoplan EOM | Least Squares (LS) Mean Change From Baseline in Total Area of GA Lesions in the Study Eye at Month 12 | 1.7563 mm^2 | Standard Error 0.07446 |
| Sham Pooled | Least Squares (LS) Mean Change From Baseline in Total Area of GA Lesions in the Study Eye at Month 12 | 1.9640 mm^2 | Standard Error 0.09592 |
LS Mean Change From Baseline in Mean Functional Reading Independence (FRI) Index Score at Month 24
The FRI was an interviewer-administered questionnaire with 7 items on functional reading activities most relevant to GA AMD subjects. It had 1 total index score. For each FRI Index reading activity performed in the past 7 days, subjects were asked about the extent to which they required assistance beyond eyeglasses/contact lenses, including the use of low-vision aids, adjustments in the activity, or help from another subject. Mean FRI Index scores ranged from 1 (unable to do independently) to 4 (totally independent), with higher scores indicating higher functional reading independence. A negative change from baseline indicated a decrease in the FRI; disease worsening. LS mean was calculated using a MMRM model. Baseline was defined as the last available, non-missing observation prior to first study drug administration.
Time frame: Baseline (screening) and Month 24
Population: The mITT analysis set consisted of all subjects assigned to treatment who received at least 1 injection of pegcetacoplan or sham and had baseline and at least 1 post-baseline value of GA lesion area in the study eye as assessed by FAF. Subjects with a baseline and at least 1 post-baseline value of the outcome at a scheduled visit by Month 24 were included in the analysis.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Pegcetacoplan Monthly | LS Mean Change From Baseline in Mean Functional Reading Independence (FRI) Index Score at Month 24 | -0.408 scores on a scale | Standard Error 0.057 |
| Pegcetacoplan EOM | LS Mean Change From Baseline in Mean Functional Reading Independence (FRI) Index Score at Month 24 | -0.371 scores on a scale | Standard Error 0.0562 |
| Sham Pooled | LS Mean Change From Baseline in Mean Functional Reading Independence (FRI) Index Score at Month 24 | -0.360 scores on a scale | Standard Error 0.0601 |
LS Mean Change From Baseline in Monocular Maximum Reading Speed of the Study Eye at Month 24
The maximum reading speed of the study eye was calculated per Minnesota Low-Vision Reading Test (MNREAD) or Radner Reading Charts user manuals, with no adjustment for reading inaccuracy. An additional step to cap resulting reading speed values at a maximum of 300 words per minute (wpm) was implemented. Maximum reading speed was calculated as the mean of the 3 highest non-zero reading speeds (or 2, or 1 value, as available), except when all wpm were calculated as 0 then the maximum reading speed was calculated as 0. LS mean was calculated using a MMRM model. Baseline was defined as the last available, non-missing observation prior to first study drug administration.
Time frame: Baseline (screening) and Month 24
Population: The mITT analysis set consisted of all subjects assigned to treatment who received at least 1 injection of pegcetacoplan or sham and had baseline and at least 1 post-baseline value of GA lesion area in the study eye as assessed by FAF. Subjects with a baseline and at least 1 post-baseline value of the outcome at a scheduled visit by Month 24 were included in the analysis.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Pegcetacoplan Monthly | LS Mean Change From Baseline in Monocular Maximum Reading Speed of the Study Eye at Month 24 | -22.897 wpm | Standard Error 4.1171 |
| Pegcetacoplan EOM | LS Mean Change From Baseline in Monocular Maximum Reading Speed of the Study Eye at Month 24 | -25.532 wpm | Standard Error 2.7676 |
| Sham Pooled | LS Mean Change From Baseline in Monocular Maximum Reading Speed of the Study Eye at Month 24 | -22.355 wpm | Standard Error 2.9341 |
LS Mean Change From Baseline in Normal-Luminance Best-Corrected Visual Acuity (NL-BCVA) Score of the Study Eye at Month 24
The NL-BCVA was assessed by early treatment diabetic retinopathy study (ETDRS) chart prior to dilating the eyes at a starting distance of 4 meters and ranged from 0 (least score) to 100 (best score). If the 4-meter score was \>19 letters read correctly, the visual acuity score was the sum of total letters correctly read at 4 meters plus the addition of 30. If the 4-meter score was ≤19 letters read correctly, the visual acuity score was the sum of total letters read correctly at 4 meters and total letters read correctly at the 1-meter distance. If no letters were read correctly at either the 4-meter distance or the 1-meter distance, the visual acuity score was 0. A positive change in the value indicated improvement in visual acuity. LS mean was calculated using a MMRM model. Baseline was defined as the last available, non-missing observation prior to first study drug administration.
Time frame: Baseline (screening) and Month 24
Population: The mITT analysis set consisted of all subjects assigned to treatment who received at least 1 injection of pegcetacoplan or sham and had baseline and at least 1 post-baseline value of GA lesion area in the study eye as assessed by FAF. Subjects with a baseline and at least 1 post-baseline value of the outcome at a scheduled visit by Month 24 were included in the analysis.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Pegcetacoplan Monthly | LS Mean Change From Baseline in Normal-Luminance Best-Corrected Visual Acuity (NL-BCVA) Score of the Study Eye at Month 24 | -8.126 ETDRS letter score | Standard Error 1.0182 |
| Pegcetacoplan EOM | LS Mean Change From Baseline in Normal-Luminance Best-Corrected Visual Acuity (NL-BCVA) Score of the Study Eye at Month 24 | -8.947 ETDRS letter score | Standard Error 1.0322 |
| Sham Pooled | LS Mean Change From Baseline in Normal-Luminance Best-Corrected Visual Acuity (NL-BCVA) Score of the Study Eye at Month 24 | -6.217 ETDRS letter score | Standard Error 1.0167 |
LS Mean Change From Baseline in the Total Area of GA Lesions in the Study Eye at Month 24
The GA lesion area was measured by a quantified central reading center based on FAF images. LS mean was calculated using a MMRM model. Baseline was defined as the last available, non-missing observation prior to first study drug administration.
Time frame: Baseline (screening) and Month 24
Population: The mITT analysis set consisted of all subjects assigned to treatment who received at least 1 injection of pegcetacoplan or sham and had baseline and at least 1 post-baseline value of GA lesion area in the study eye as assessed by FAF. Subjects with a baseline and at least 1 post-baseline value of the outcome at a scheduled visit by Month 24 were included in the analysis.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Pegcetacoplan Monthly | LS Mean Change From Baseline in the Total Area of GA Lesions in the Study Eye at Month 24 | 3.2275 mm^2 | Standard Error 0.12457 |
| Pegcetacoplan EOM | LS Mean Change From Baseline in the Total Area of GA Lesions in the Study Eye at Month 24 | 3.3395 mm^2 | Standard Error 0.13034 |
| Sham Pooled | LS Mean Change From Baseline in the Total Area of GA Lesions in the Study Eye at Month 24 | 3.9726 mm^2 | Standard Error 0.1682 |
Mean Change in Total Area of GA Lesions in the Study Eye Through Month 24
The mean change in GA lesion area through Month 24 was measured by assuming a piecewise linear trend in time with knots by FAF images at Months 6, 12, and 18 and was calculated using a MMRM model. Baseline was defined as the last available, non-missing observation prior to first study drug administration.
Time frame: From Baseline (screening) through Month 24
Population: The mITT analysis set consisted of all subjects assigned to treatment who received at least 1 injection of pegcetacoplan or sham and had baseline and at least 1 post-baseline value of GA lesion area in the study eye as assessed by FAF.
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| Pegcetacoplan Monthly | Mean Change in Total Area of GA Lesions in the Study Eye Through Month 24 | From Month 18 to Month 24 | 0.6262 mm^2 | Standard Error 0.06809 |
| Pegcetacoplan Monthly | Mean Change in Total Area of GA Lesions in the Study Eye Through Month 24 | From Month 12 to Month 18 | 0.9033 mm^2 | Standard Error 0.04917 |
| Pegcetacoplan Monthly | Mean Change in Total Area of GA Lesions in the Study Eye Through Month 24 | From Baseline to Month 6 | 0.9075 mm^2 | Standard Error 0.04755 |
| Pegcetacoplan Monthly | Mean Change in Total Area of GA Lesions in the Study Eye Through Month 24 | From Month 6 to Month 12 | 0.8409 mm^2 | Standard Error 0.05128 |
| Pegcetacoplan Monthly | Mean Change in Total Area of GA Lesions in the Study Eye Through Month 24 | From Baseline to Month 24 | 3.2780 mm^2 | Standard Error 0.12525 |
| Pegcetacoplan EOM | Mean Change in Total Area of GA Lesions in the Study Eye Through Month 24 | From Month 12 to Month 18 | 0.8803 mm^2 | Standard Error 0.05105 |
| Pegcetacoplan EOM | Mean Change in Total Area of GA Lesions in the Study Eye Through Month 24 | From Baseline to Month 6 | 0.8829 mm^2 | Standard Error 0.0466 |
| Pegcetacoplan EOM | Mean Change in Total Area of GA Lesions in the Study Eye Through Month 24 | From Month 6 to Month 12 | 0.8473 mm^2 | Standard Error 0.05086 |
| Pegcetacoplan EOM | Mean Change in Total Area of GA Lesions in the Study Eye Through Month 24 | From Month 18 to Month 24 | 0.6946 mm^2 | Standard Error 0.05256 |
| Pegcetacoplan EOM | Mean Change in Total Area of GA Lesions in the Study Eye Through Month 24 | From Baseline to Month 24 | 3.3051 mm^2 | Standard Error 0.12871 |
| Sham Pooled | Mean Change in Total Area of GA Lesions in the Study Eye Through Month 24 | From Baseline to Month 24 | 4.0031 mm^2 | Standard Error 0.1688 |
| Sham Pooled | Mean Change in Total Area of GA Lesions in the Study Eye Through Month 24 | From Month 18 to Month 24 | 0.9794 mm^2 | Standard Error 0.05469 |
| Sham Pooled | Mean Change in Total Area of GA Lesions in the Study Eye Through Month 24 | From Baseline to Month 6 | 0.9622 mm^2 | Standard Error 0.04983 |
| Sham Pooled | Mean Change in Total Area of GA Lesions in the Study Eye Through Month 24 | From Month 12 to Month 18 | 1.0483 mm^2 | Standard Error 0.05574 |
| Sham Pooled | Mean Change in Total Area of GA Lesions in the Study Eye Through Month 24 | From Month 6 to Month 12 | 1.0132 mm^2 | Standard Error 0.05998 |