A current research revealed within the journal JAMA Ophthalmology evaluated associations between semaglutide and the danger of non-arteritic anterior ischemic optic neuropathy (NAION).
NAION is a major explanation for grownup blindness and the second most typical optic neuropathy. Semaglutide is a glucagon-like peptide (GLP)-1 receptor agonist (RA) authorised by the US (US) Meals and Drug Administration to deal with weight problems and sort 2 diabetes (T2D). Weekly new prescriptions of those and different GLP-1 RAs have elevated by 60% within the US between 2021 and 2023. Nevertheless, anecdotal stories recommend that semaglutide could be related to NAION.
Research: Threat of Nonarteritic Anterior Ischemic Optic Neuropathy in Sufferers Prescribed Semaglutide. Picture Credit score: MattL_Images / Shutterstock
In regards to the research
Within the current research, researchers evaluated the danger of NAION amongst semaglutide customers. Sufferers referred to a clinic for neuro-ophthalmology indications between December 2017 and November 2023 had been recognized for inclusion from the Massachusetts Common Brigham centralized knowledge registry. Digital well being information had been queried to determine NAION occasions.
Every recognized file was reviewed manually to verify the NAION prognosis. Folks with chubby/weight problems or T2D had been individually analyzed. People who didn’t use semaglutide had been included for comparability. Intercourse/gender and race had been self-reported. The research populations had been T2D sufferers prescribed semaglutide or non-GLP-1 RA anti-diabetic medicines and overweight/chubby sufferers prescribed semaglutide or non-GLP-1 RA weight reduction medicines.
Non-GLP-1 RA anti-diabetic medicines included thiazolidinediones, sulfonylureas, metformin, insulin, and inhibitors of sodium-glucose transport protein 2, dipeptidyl peptidase 4, or α-glucosidase. Additional, non-GLP-1 RA weight reduction medicines included setmelanotide, phentermine, topiramate, orlistat, naltrexone, and bupropion.
For stability between cohorts (semaglutide customers and non-users), 1:2 nearest-neighbor propensity rating matching was utilized to account for demographic elements, contraindications for semaglutide, indications for semaglutide use, and use of NAION-associated medicine. The first consequence was a NAION occasion. Cumulative incidence of NAION was estimated utilizing the Kaplan-Meier methodology.
Individual-time was calculated from prescription to NAION occasion, finish of follow-up (36 months), or loss of life. Cox proportional hazards regression analyzed the associations between covariates and NAION danger. The log-rank take a look at was used to evaluate survival occasions. As well as, secondary analyses had been carried out with 1:1 nearest-neighbor propensity rating matching and an actual match for baseline variables differing by ≥ 20% between cohorts for every research inhabitants.
Findings
The researchers recognized practically 17,300 distinctive affected person information; of those, 16,827 sufferers had been included, following the exclusion of individuals beneath 12 years. General, 979 people had been chubby or overweight, and 710 had T2D. Within the T2D group, NAION occurred in 17 sufferers utilizing semaglutide and 6 non-semaglutide customers. The typical follow-up length was 33.3 and 34.5 semaglutide customers and non-users, respectively.
The cumulative incidence of NAION at 36 months was 8.9% for the semaglutide cohort and 1.8% for the non-semaglutide cohort. The survival likelihood declined sharply over the primary 12 months for semaglutide customers. Semaglutide customers had the next danger of NAION than non-users, with a hazard ratio of 4.28. In secondary analyses, 264 sufferers with no historical past of NAION had been included; the elevated danger of NAION was sustained for semaglutide customers.
Within the chubby/weight problems group, 20 semaglutide customers and three non-users developed NAION. The semaglutide and non-semaglutide cohorts had been adopted up for 34.1 and 35.4 months, respectively. The cumulative incidence of NAION was 6.7% and 0.8% for the semaglutide and non-semaglutide cohorts, respectively, at 36 months.
Likewise, the survival likelihood confirmed a steep decline within the first 12 months for semaglutide customers. In comparison with the non-semaglutide cohort, the semaglutide cohort had an elevated danger of NAION, with a hazard ratio of seven.64. Secondary analyses included 442 sufferers with out NAION, and the danger of NAION was constantly larger within the semaglutide cohort.
Conclusions
The findings point out that semaglutide use is related to an elevated danger of NAION. The comparatively excessive hazard ratios underscore the considerably elevated danger of NAION amongst semaglutide customers in comparison with these prescribed non-GLP-1 RA drugs for weight problems and T2D. The chance didn’t look like because of variations in baseline traits between cohorts.
The research’s limitations embody restricted generalizability to different settings and ethnic/racial teams and non-assessment of adherence to the prescribed medication. Taken collectively, the research uncovered an affiliation between semaglutide and NAION; additional large-scale, multicenter, population-based research are required to corroborate these findings.
