Adults prescribed semaglutide may have increased risk for form of optic neuropathy
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Key takeaways:
- Adults prescribed semaglutide were more likely to develop nonarteritic anterior ischemic optic neuropathy than those using non-GLP-1 medications.
- More studies are needed to determine causality.
Adults with diabetes or obesity using semaglutide may have an increased risk for nonarteritic anterior ischemic optic neuropathy, a common form of optic neuropathy, according to data published in JAMA Ophthalmology.
Nonarteritic anterior ischemic optic neuropathy (NAION) is a form of optic neuropathy that can cause blindness among adults. In a single-center retrospective study of neuro-ophthalmic patients, adults prescribed semaglutide (Ozempic/Wegovy, Novo Nordisk) for the treatment of type 2 diabetes or obesity had higher rates of NAION during a follow-up of 3 years compared with adults taking other non-GLP-1 receptor agonist medications.
“The relatively high HRs ... identified by our Cox regression analyses reveal a substantially increased risk of NAION among individuals prescribed semaglutide relative to those prescribed other medications to treat type 2 diabetes and obesity or overweight,” Joseph F. Rizzo III, MD, professor of ophthalmology and director of the neuro-ophthalmology service at Harvard Medical School and Massachusetts Eye and Ear in Boston, and colleagues wrote. “This risk appears not to be due to differences in baseline characteristics between the cohorts.”
Researchers obtained electronic health record data from adults who attended Massachusetts Eye and Ear for a presumed neuro-ophthalmology indication from Dec. 1, 2017, to Nov. 20, 2023. Two separate analyses were conducted. Adults with type 2 diabetes prescribed semaglutide were matched, 1:2, with adults prescribed a non-GLP-1 diabetes drug, and adults with overweight or obesity prescribed semaglutide were matched, 1:2, with adults prescribed a non-GLP-1 obesity medication. NAION events were identified from medical records by searching for the ICD-10 code for ischemic optic neuropathy and conducting a text search for nonarteritic anterior ischemic optic neuropathy or the abbreviation NAION.
Among 710 adults with type 2 diabetes, (52% women; median age, 59 years) 194 were prescribed semaglutide and 516 were prescribed a non-GLP-1 medication. There were 17 NAION events in the semaglutide group and six events in the non-GLP-1 group. At 3 years, the semaglutide group had an 8.9% cumulative incidence of NAION compared with a 1.8% incidence for the comparator group. Adults prescribed semaglutide had a higher risk for NAION events than those prescribed non-GLP-1 drugs (HR = 4.28; 95% CI, 1.62-11.29; P < .001).
Of 979 adults with overweight or obesity (72% women; median age, 47 years), 361 were prescribed semaglutide and 618 were prescribed non-GLP-1 drugs. NAION events occurred in 20 adults in the semaglutide group and three adults receiving other medications. The cumulative incidence for NAION events was 6.7% for those prescribed semaglutide and 0.8% for those prescribed other obesity medications. Adults prescribed semaglutide had a higher risk for NAION events than those prescribed non-GLP-1 drugs (HR = 7.64; 95% CI, 2.21-26.36; P < .001).
Findings in both the type 2 diabetes and obesity groups were similar in a secondary analysis using 1:1 propensity score matching plus an exact match of variables differing by 20% or more between groups.
The researchers cautioned that causality cannot be established due to the study design. They also discussed challenges with conducting a larger study due to the lack of a specific ICD-10 diagnostic code for NAION.
“The best approaches to confirm, refute, or refine our findings would be to conduct a much larger, retrospective, multicenter population-based cohort study; a prospective, randomized clinical study; or a post-market analysis of all GLP-1 receptor agonist drugs,” the researchers wrote.
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