Syfovre vs. Izervay: How the Two Geographic Atrophy Drugs Compare
Syfovre and Izervay at a Glance
Both drugs are shots given into the eye, and most shots go smoothly. Still, a rare infection or a rare burst of inflammation inside the eye can begin days after a shot. Both labels warn that an eye injection can be followed by an infection inside the eye (clinical: endophthalmitis) or by a retinal detachment12. Learn these signs before your first shot. Call your eye doctor the same day if any of them appear, above all in the first week or two after a shot.
- Sudden vision loss, or vision that keeps getting worse
- Severe eye pain, or pain that grows instead of fading
- A red eye with discharge, or new light sensitivity
- A sudden shower of new floaters, or flashing lights
Mild soreness, a small red patch on the white of the eye, and a few floaters for a day or two are common. They usually settle on their own. The signs in that list are different. They point to a problem that doctors can often control when it is caught early, so speed matters more than certainty. Do not wait for your next visit. Call the office that gave the shot, and go to an emergency room if you cannot reach anyone.
Syfovre and Izervay are the first two drugs approved in the United States for geographic atrophy, the advanced dry form of age-related macular degeneration. They act on the same immune pathway at different points. Syfovre blocks a complement protein called C3. Izervay blocks a complement protein called C5, one step further along the same chain3. The everyday difference is the schedule. Syfovre is given every 25 to 60 days, so it can be spaced to every other month1, while Izervay is given once a month, about every 28 days2. Both slow damage. Neither restores sight.
Use this page to bring sharper questions to your retina appointment, not to pick a drug on your own. No study has put these two drugs head to head, so nobody can honestly tell you that one is better. What a specialist can tell you is how much atrophy you have, where it sits, how fast it has moved on your scans, and whether the schedule and risks fit your life.
What Geographic Atrophy Is and What Each Drug Does
Geographic atrophy is patchy, permanent loss of the light-sensing cells and their support layer in the macula. The macula is the small central part of the retina you read and recognize faces with. Age-related macular degeneration is very common, affecting about 11 million people in the United States, and the dry form usually worsens slowly across several years4. It takes central vision and leaves side vision alone5. That is why a familiar room stays navigable long after reading has become hard. Once a patch of retina is gone, no treatment brings it back, so slowing the spread is the goal.
Syfovre is the brand name for pegcetacoplan. It was the first drug approved in the United States for geographic atrophy, in February 2023. The dose is 15 mg, injected into the jelly of the eye, in each affected eye, once every 25 to 60 days1. That window is what allows either a monthly or an every-other-month rhythm, and your specialist sets the spacing with you. The eye is numbed and cleaned with an antiseptic first, and the shot takes seconds. Treatment continues as long as you and your doctor judge it worth continuing.
Izervay is the brand name for avacincaptad pegol, approved in the United States in August 2023, about six months after Syfovre. The dose is 2 mg injected into the eye, in each affected eye, once a month, and the label sets no maximum length of treatment2. The visit looks much like a Syfovre visit: numbing drops, antiseptic, a brief injection, then a check before you go home. The practical difference is that a monthly rhythm is the only rhythm on offer.
How Syfovre and Izervay Compare, Side by Side
Most of what separates these two drugs day to day fits in a short table. The trial numbers come next.
| What you are comparing | Syfovre | Izervay |
|---|---|---|
| What it blocks | Complement protein C3 | Complement protein C5 |
| Dose | 15 mg into the eye | 2 mg into the eye |
| How often | Every 25 to 60 days | Once a month |
| Approved in the US | February 2023 | August 2023 |
| Main trials | OAKS and DERBY | GATHER1 and GATHER2 |
| Length of treatment | Ongoing, no set end | Ongoing, no set end |
Notice what the table does not have: a column for how much vision each drug saves. That column does not exist yet.
Both programs measured the same thing: how fast the area of atrophy grew on retinal images, against a sham injection. The Syfovre label reports this as a modeled rate of growth in lesion area over 24 months rather than as an amount of vision saved: in the OAKS trial that rate was about 3.11 square millimeters on monthly Syfovre against about 3.98 on sham, which the label states as a 21.9% reduction (roughly a fifth), and in the DERBY trial about 3.28 against 4.00, stated as an 18.1% reduction1. The Izervay label reports the same kind of measure over 12 months rather than 24: in the GATHER1 trial the patch grew by about 1.22 square millimeters a year on Izervay against about 1.89 on sham, a gap the label states as slowing growth by about 35 out of every 100, and in the GATHER2 trial about 1.75 against about 2.12, stated as about 18 out of every 1002. The American Academy of Ophthalmology sums both programs up as slowing growth by roughly 14 to 20 out of every 1006.
This part is worth reading twice. Neither drug has been shown to improve eyesight or bring back vision already lost6. In a review of both approval programs in the American Journal of Ophthalmology, Csaky and colleagues note that neither program showed a benefit on its pre-specified vision measures, and that the average effect works out to delaying the growth of atrophy by roughly four and a half months7. That is a real effect on the retina, measured carefully. It is also a smaller promise than the phrase 'the first treatment' suggests. Knowing that early tends to make the decision easier, not harder.
It is tempting to set Syfovre's 22 out of every 100 next to Izervay's 35 and declare a winner. That comparison does not hold. The two programs enrolled different patients, and measured growth over different windows, 24 months in one case and a single year in the other, with different statistical models, so the numbers do not come off the same ruler. No trial has given one group Syfovre and another group Izervay and compared them. Researchers have tried to bridge the gap with statistical matching between trials, but an indirect comparison is an estimate built on assumptions, not a result. Anyone who tells you flatly that one drug beats the other is going past the evidence.
Risks, Side Effects, and the Realistic Outlook
Every injection into the eye carries the same small set of risks, and these two are no exception. Infection inside the eye, retinal detachment, bleeding in the front of the eye and retinal tears were reported in fewer than 1 in 100 patients in the Syfovre trials1. Both labels also warn about eye pressure after the shot, in different words: the Izervay label describes transient rises in pressure, while the Syfovre label warns that an acute rise in pressure can occur within minutes of any injection into the eye and that the blood supply to the optic nerve should be watched afterward. Both labels list bleeding under the clear surface of the eye among the common reactions21. Rare does not mean impossible. Caught early, these problems are usually treatable.
Both drugs raise the chance of converting to the wet form of macular degeneration, which then needs its own separate injections. By month 24 in the Syfovre trials, new wet macular degeneration appeared in about 12 of every 100 eyes treated monthly and about 7 of every 100 treated every other month, against about 3 of every 100 given sham1. With Izervay it appeared in about 7 of every 100 at 12 months against about 4 of every 100 with sham, and by 24 months in GATHER2 in about 12 of every 100 against about 9 of every 100 with sham2. Those sham rates differ between the two programs, so do not subtract one drug's number from the other's. Wet macular degeneration has its own treatments, and catching it early matters, which is part of why you are seen so often.
One safety signal belongs to Syfovre alone. Its label warns that inflammation of the retinal blood vessels, with or without a blockage of those vessels, has been reported, that it can happen after the very first injection, and that it can cause severe vision loss1. A safety committee of the American Society of Retina Specialists, writing in the Journal of VitreoRetinal Diseases, confirmed 14 affected eyes in 13 patients, appearing a median of about 10 days after a first injection, with 2 eyes later removed. The committee noted that the true rate is not known, because the number of injections given was never counted8. Reported cases are few, but the committee could not work out a rate, and the harm to the eyes involved was severe. That combination is why it belongs in your decision rather than in the fine print.
A good result here is quiet: scan after scan showing the atrophy creeping outward more slowly than it would have. You will not feel it working, and you will not read an extra line on the chart because of it. Your vision will most likely still decline, only later than it would have. Population averages describe groups, never one person, so no specialist can tell you how much time this buys you. If your yardstick is stability, treatment can be worth it. If you hoped to read again, this is not the tool for that.
Deciding With Your Retina Specialist
Both drugs are licensed for the same narrow purpose. Each is indicated for geographic atrophy secondary to age-related macular degeneration, given by injection into each affected eye21. They are not for early or intermediate dry macular degeneration, not for wet macular degeneration, and not for atrophy from another cause. Your specialist confirms the diagnosis with retinal imaging, usually including scans that map the atrophy so its growth can be tracked. Where your atrophy sits matters too, since a patch that has not yet reached the center threatens something you still have.
The two drugs share their firm barriers and differ in their cautions. Neither is to be given when there is an infection in or around the eye, or active inflammation inside the eye. Syfovre also lists a known hypersensitivity to the drug as a reason not to use it12. Beyond that, the fork is practical. If a past episode of inflammation inside the eye weighs on you, or the vasculitis reports do, that argues against Syfovre. If reaching the clinic every single month is the hard part, the every-other-month option argues against Izervay. Tell your specialist which of those two problems is bigger for you.
Treatment is a standing commitment, not a course. Csaky and colleagues describe an expectation of treatment continuing indefinitely, every four to eight weeks7. Count what that costs you in rides, in a companion's time off work, and in the day after each shot. On money: a 2024 comparison letter in Annals of African Medicine by Patel and colleagues reported a list price of about 2,190 dollars per dose of Syfovre and about 2,100 dollars per dose of Izervay3. Because both are given in a clinic, they are usually billed through medical benefits rather than a pharmacy plan. Ask the office to check your coverage before your first appointment.
When to Call, and Who to See
After a shot, expect a scratchy feeling for a day, a red spot where the needle went in, and sometimes a few extra floaters. All of that fades. The pattern that should worry you is the opposite one: symptoms that arrive late or get worse instead of better. Pain that builds over several days, vision that dims further, or growing redness with light sensitivity all fit that pattern. Anything on that path deserves a phone call to the office that treated you.
Home monitoring is one way a wet conversion gets caught early, alongside the scans at your visits. The American Academy of Ophthalmology advises checking an Amsler grid every day, one eye at a time, and contacting your ophthalmologist right away if lines look wavy, blurry or dim5. New distortion, a new dark patch, or a change in how straight edges look is not something to save for your next visit. Keep the grid where you will use it, and test with your glasses on in good light.
These injections are given by retina specialists, ophthalmologists with extra fellowship training in diseases of the back of the eye. Your optometrist or general ophthalmologist may be the one who spots the atrophy and refers you. If you are weighing whether to start at all, a second opinion from another retina specialist is a reasonable request. Low-vision rehabilitation is a separate referral worth asking about, since it addresses the daily reading tasks neither drug improves.
Common Questions About Syfovre and Izervay
Nobody can answer that from today's evidence. The two have never been tested against each other in one trial, and their separate trials used different patients, follow-up lengths and measures, so the results cannot be ranked. The honest way to choose is on fit rather than rank: the schedule you can sustain, your history of eye inflammation, how you weigh the vasculitis reports, and what your specialist sees on your scans.
No. Neither drug has been shown to improve vision or bring back sight already lost. What they were shown to do is slow the growth of the atrophic patch on imaging. Whatever reading or driving vision you have today is what treatment tries to protect for longer, not a baseline the drug is expected to raise. If a clinic promises you sharper sight from one of these injections, treat that as a reason to get another opinion.
There is no fixed course. Both drugs are meant to continue indefinitely, roughly every four to eight weeks, for as long as you and your specialist agree the benefit is worth the burden. People revisit the decision periodically, especially if the atrophy reaches the center of vision, if travel becomes too hard, or if a complication happens. Stopping is a legitimate choice made with your doctor, not a failure.
Switching is possible and is done, most often because of a side effect, a schedule that is not workable, or an insurance change. There is no trial evidence telling us whether switching helps, hurts, or makes no difference, so it is a clinical judgment rather than a rule. If you are considering it, be specific about what you want to change: the number of visits, a reaction you had, or one particular risk.
Most people describe pressure rather than pain. The eye is numbed with drops or gel before the antiseptic and the shot, which takes only seconds. Afterward the antiseptic often leaves the eye scratchy for several hours, and artificial tears help. Soreness that arrives later or builds over days is a different matter and needs a same-day call. If the visit itself is what you dread, say so, because the numbing routine can usually be adjusted.
Choosing not to treat is a reasonable option that many people take. Geographic atrophy tends to enlarge slowly over years whether or not it is treated, and treatment changes the pace rather than the direction. Without injections you avoid the visit burden, the injection risks and the higher chance of wet conversion, and you keep the option of starting later. What you give up is the modest slowing. Monitoring, home Amsler checks and low-vision support all stay available.
More Questions About Living With Treatment
Yes. Both labels describe treating each affected eye, so if geographic atrophy is in both, both can be treated. Many specialists inject one eye per visit or stagger the two eyes, so that a complication does not affect both eyes at once. That also doubles the appointments unless both eyes are done the same day. Ask how your practice handles second eyes and why.
Usually, though the details vary and it is worth confirming before you start. These drugs are given in a clinic rather than picked up at a pharmacy, so they are typically billed through medical benefits, and many plans ask for proof that the atrophy was confirmed on retinal imaging. Your share depends on your plan and any secondary coverage. Ask the practice for a written benefits check, and about any assistance programs you might qualify for.
Do not change anything on your own. Ask the specialist who manages your macular degeneration. The supplement question and the injection question are separate decisions with separate evidence behind them, and starting one of these drugs is not by itself a reason to stop a supplement your doctor recommended. Bring the actual bottle so the exact formula can be checked, along with your other eye drops and medicines, since your specialist needs the full list before your first injection.
Arrange a ride, because your eye will be dilated and blurry for hours afterward. Bring sunglasses, your medicine list and your glasses. Expect the visit to run longer than the injection itself, since imaging, dilation and a pressure check surround the few seconds of treatment. Before you leave, ask which symptoms should trigger a same-day call and what number to use after hours, then write that number where you can find it.
- How much atrophy do I have now, how fast has it grown on my scans, and how close is it to the center of my vision?
- Given my history, do you favor Syfovre or Izervay for me, and what is your reasoning?
- What schedule would I be committing to, and how long before we reassess?
- How do you weigh the retinal vasculitis reports with Syfovre for someone like me?
- What is my chance of converting to wet macular degeneration on treatment, and how would we catch it?
- What exactly should make me call you the same day, and what number do I use after hours?
- U.S. Food and Drug Administration approved label, via DailyMed (2025). SYFOVRE (pegcetacoplan injection), for intravitreal use - full prescribing information.
- U.S. Food and Drug Administration approved label, via DailyMed (2026). IZERVAY (avacincaptad pegol intravitreal solution) - full prescribing information.
- Patel H, Kutikuppala LVS, Sharma S, et al. Annals of African Medicine 2024;23(3):523-524 (2024). Izervay versus Syfovre: Two Rivals Recently Approved for Management of Geographic Atrophy.
- National Eye Institute (2021). Age-Related Macular Degeneration (AMD).
- American Academy of Ophthalmology, EyeSmart (reviewed by Veena R. Raiji, MD) (2025). What Is Macular Degeneration?.
- American Academy of Ophthalmology, EyeSmart (reviewed by Rahul N. Khurana, MD) (2025). What to Know About Syfovre and Izervay for Geographic Atrophy.
- Csaky KG, Miller JML, Martin DF, Johnson MW. American Journal of Ophthalmology 2024;263:231-239 (2024). Drug Approval for the Treatment of Geographic Atrophy: How We Got Here and Where We Need to Go.
- Witkin AJ, Jaffe GJ, Srivastava SK, Davis JL, Kim JE. Journal of VitreoRetinal Diseases 2024 (2024). Retinal Vasculitis After Intravitreal Pegcetacoplan: Report From the ASRS Research and Safety in Therapeutics (ReST) Committee.