• Enoch Kassa, Thomas A Ciulla, Rehan M Hussain, and Pravin U Dugel.
• a Department of Ophthalmology , Indiana University School of Medicine , Indianapolis , IN , USA.
• Expert Opin Biol Ther. 2019 Apr 1; 19 (4): 335-342.

IntroductionDry age-related macular degeneration (AMD) and Stargardt Macular Dystrophy (STGD1) result in vision loss due to progressive atrophy of the macula and lack of effective treatments. Numerous studies have implicated complement-associated inflammation as a contributor to both diseases.Areas CoveredThe complement factor D inhibitor, lampalizumab, failed to halt geographic atrophy (GA) progression in phase 3 studies. The complement factor 3 (C3) inhibitor, APL-2, has shown potential to reduce GA growth in a phase 2 trial, supporting advancement to phase 3 trials. The intravenous complement factor 5 (C5) inhibitor, eculizumab, failed to halt GA progression in a phase 2 study. Another C5 inhibitor, avacincaptad pegol, is delivered by intravitreal injection, and will be studied for safety and preliminary signs of efficacy for AMD and STGD1 patients in phase 2 trials. LFG316 (C5 inhibitor) and CLG561 (properdin inhibitor) failed to halt GA progression in phase 2 studies. A phase 1 trial is evaluating the effects of combining LFG316 and CL561. Complement inhibition by gene therapy will be explored in the phase 1 trial of HMR59 in AMD patients.Expert OpinionWhile complement inhibition has not yet demonstrated the ability to halt GA progression in a phase 3 trial, further study is warranted.

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