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pegcetacoplan

Sold as Empaveli, Syfovre. Class: Complement inhibitors. First FDA approval 05/14/2021: 5 years on the US market.

This grade answers one narrow question: how strong is the public evidence and safety record behind this drug, and how clean is its money trail and court record? It is not a verdict on whether the drug is right for you.

C

Score breakdown (67/100)

Safety ×35%
B
Evidence ×25%
F
Regulatory ×15%
C
Money & lawsuits ×15%
C
Options ×10%
C

Safety: 85

Evidence: 38

Regulatory history: 67

Money & lawsuits: 70

Options: 70

What the FDA label says

Approved uses

is indicated for the treatment of geographic atrophy (GA) secondary to age-related macular degeneration (AMD). SYFOVRE is a complement inhibitor indicated for the treatment of geographic atrophy (GA) secondary to age-related macular degeneration (AMD). ( 1 )

Contraindications

Ocular or Periocular Infections ( 4.1 ) Active Intraocular Inflammation ( 4.2 ) Hypersensitivity ( 4.3 ) 4.1 Ocular or Periocular Infections SYFOVRE is contraindicated in patients with ocular or periocular infections [see Warnings and Precautions (5.1) ] . 4.2 Active Intraocular Inflammation SYFOVRE is contraindicated in patients with active intraocular inflammation. 4.3 Hypersensitivity SYFOVRE is contraindicated in patients with hypersensitivity to pegcetacoplan or to any of the excipients in SYFOVRE. Systemic hypersensitivity reactions (e.g., anaphylaxis, rash, urticaria) have occurred in patients treated with SYFOVRE [see Adverse Reactions (6.2) ] .

Warnings and precautions

Endophthalmitis and Retinal Detachments ( 5.1 ) Retinal Vasculitis and/or Retinal Vascular Occlusion ( 5.2 ) Neovascular AMD ( 5.3 ) Intraocular inflammation ( 5.4 ) Increased Intraocular Pressure ( 5.5 ) 5.1 Endophthalmitis and Retinal Detachments Intravitreal injections, including those with SYFOVRE, may be associated with endophthalmitis and retinal detachments [see Adverse Reactions (6.1) ] . Proper aseptic injection technique must always be used when administering SYFOVRE in order to minimize the risk of endophthalmitis [see Dosage and Administration (2.4) ] . Patients should be instructed to report any symptoms suggestive of endophthalmitis or retinal detachment without delay and should be managed appropriately. 5.2 Retinal Vasculitis and/or Retinal Vascular Occlusion Retinal vasculitis and/or retinal vascular occlusion, typically in the presence of intraocular inflammation, have been reported with the use of SYFOVRE [see Adverse Reactions (6.2) ] . Cases may occur with the first dose of SYFOVRE and may result in severe vision loss. Discontinue treatment with SYFOVRE in patients who develop these events. Patients should be instructed to report any change in vision without del...

Adverse reactions (label)

The following clinically significant adverse reactions are described elsewhere in the labeling: Ocular and periocular infections [see Contraindications (4.1) ] Active intraocular inflammation [see Contraindications (4.2) ] Hypersensitivity [see Contraindications (4.3) ] Endophthalmitis and retinal detachments [see Warnings and Precautions (5.1) ] Retinal Vasculitis and/or Retinal Vascular Occlusion [see Warnings and Precautions (5.2) ] Neovascular AMD [see Warnings and Precautions (5.3) ] Intraocular inflammation [see Warnings and Precautions (5.4) ] Increased intraocular pressure [see Warnings and Precautions (5.5) ] Most common adverse reactions (incidence ≥5%) are ocular discomfort, neovascular age-related macular degeneration, vitreous floaters, and conjunctival hemorrhage. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Apellis Pharmaceuticals, Inc. at 1-833-866-3346 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not ref...

Recent major label changes

Dosage and Administration, Preparation for Administration ( 2.3 ) 7/2025 Contraindications, Hypersensitivity ( 4.3 ) 12/2024

Source: FDA SPL label for Syfovre (Apellis Pharmaceuticals, Inc.), effective 20250916. Full label on DailyMed.

Side-effect reports sent to the FDA

These are counts of reports people filed, not rates of harm. Anyone can file one, and nobody checks whether the drug was the cause. Millions of doses are taken for every report sent, so the useful part is how this drug compares with the average across all drugs.

1,780reports that mention this drug
1,779of those blame this drug, not another one the person was taking
66%of reports describe a serious outcome, such as a hospital stay (average for all drugs: 57%)
5.8%of reports include a death, from any cause (average for all drugs: 9.1%)

Problems reported most often

Fatigue · 159Off Label Use · 144Visual Impairment · 137Haemoglobin Decreased · 124Vitreous Floaters · 112Haemolysis · 107Breakthrough Haemolysis · 91Headache · 87Uveitis · 79Vitritis · 73Drug Ineffective · 69Product Dose Omission Issue · 67Eye Inflammation · 66Choroidal Neovascularisation · 64Vision Blurred · 63

Reports per year

202120222023202420252026
2356296786399220

Source: the FDA's Adverse Event Reporting System (FAERS). Reports are voluntary and unverified. Drugs that are prescribed a lot, in the news, or in lawsuits attract more reports, so the percentages are compared with the whole database to correct for that partly, not fully.

Recalls and regulatory record

0recall actions on file
2 / 0brand / generic applications
5label changes since 2021
YesREMS program

Evidence base

29randomized trials (PubMed)
2systematic reviews
36registered trials
88%of completed trials posted results
11%terminated or withdrawn
92%industry-funded

Counts measure how much evidence exists and how transparent it is, not how big the benefit is. For that, ask your prescriber: if 100 people like me took this, how many would get better because of it, and how many would be harmed? (Doctors call these the "number needed to treat" and "number needed to harm.") It differs by condition and is the number drug ads leave out. Sources: PubMed, ClinicalTrials.gov.

Money and lawsuits

In 2024, drug companies reported $2,461,703 in payments to US physicians and hospitals tied to this drug across 7,918 transactions (Syfovre $2,288,394, Empaveli $173,309).

No pending federal MDL names this drug or its brands.

Not named in any federal pharmaceutical settlement of $100M or more on record.

Sources: CMS Open Payments (Sunshine Act); Judicial Panel on Multidistrict Litigation pending docket list; DOJ settlements as tabulated on Wikipedia with links to the primary record. State-court and individual suits are not included.

Who takes it and what it costs

71Medicare Part D patients (2024)
704prescriptions filled
$40,574average cost per fill
$29Mtotal Medicare spend

Same-class alternatives

avacopancrovalimabdanicopaniptacopanpozelimabsutimlimabvilobelimabzilucoplan

Same ATC pharmacological class, graded ones first, best grade at the top. Being in the same class does not make them interchangeable for your condition; it makes them worth asking about.

Questions to ask your prescriber

  1. This drug has a REMS safety program. What monitoring does that require from us?
  2. The most-reported problems in FDA's adverse event data are fatigue, visual impairment, haemoglobin decreased. How would we recognize and handle those?
  3. Off-label use is among the most-reported items for this drug. Is my use on-label, and if not, what evidence supports it?
  4. Why this one over avacopan, crovalimab, danicopan? What would make you pick one of those instead?
  5. There is no generic. Is there an older generic in the same class that works as well for my situation?
  6. The manufacturer pays physicians heavily to promote this drug. Have you received anything from them?
  7. What result are we expecting, by when, and what is the plan if it does not happen?
  8. If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)