GLP-1s not tied to higher risk for form of optic neuropathy that may cause blindness
Click Here to Manage Email Alerts
Key takeaways:
- Adults with type 2 diabetes or obesity using a GLP-1 had a similar risk for NAION as those using non-GLP-1 drugs.
- The findings were similar in a sensitivity analysis comparing semaglutide with non-GLP-1 drugs.
Adults using a GLP-1 receptor agonist do not have increased risk for nonarteritic anterior ischemic optic neuropathy, according to data from a retrospective analysis published in Journal of Diabetes Science and Technology.
As Healio previously reported, a study published in JAMA Ophthalmology found adults attending Massachusetts Eye and Ear who were prescribed semaglutide (Ozempic/Wegovy, Novo Nordisk) had a higher risk for developing nonarteritic anterior ischemic optic neuropathy (NAION) than those using a non-GLP-1 receptor agonist. However, David C. Klonoff, MD, FACP, FRCP (Edin), Fellow AIMBE, medical director of the Dorothy L. and James E. Frank Diabetes Research Institute of Mills-Peninsula Medical Center, told Healio that the study had several limitations, including the single-center design and the study population consisting only of people attending an ophthalmology clinic. Klonoff and colleagues conducted a series of retrospective analyses to assess NAION risk with GLP-1 use in a large electronic health record and claims database.
“When the data from our real-world database of 66 million regular people were analyzed ... no significant increase in blindness due to NAION was noted in people using semaglutide or other drugs in that same GLP-1 receptor agonist family compared to people using other drugs for weight loss,” Klonoff told Healio. “It is possible that a future study will show something different, but if a proper test group is studied like we did, and if a large number of potential patients is studied, like we did, then I expect that additional studies of this topic will demonstrate similar results. Our study should provide some reassurance to people using a GLP-1 receptor agonist drug who are concerned about its potential side effects.”
Researchers collected data from a real-world database of 66 million patients in the U.S. Adults using a GLP-1 receptor agonist or other weight-loss medication with no prior history of NAION were included. The primary analysis assessed risk for NAION among adults using a GLP-1 receptor agonist with adults using non-GLP-1 medications.
No increased risk for NAION
After controlling for confounders, adults using a GLP-1 had no difference in NAION risk than those using non-GLP-1 medications.
The findings were similar in six sensitivity analyses. In an analysis only including adults with type 2 diabetes, there was no difference in NAION risk between the GLP-1 and non-GLP-1 groups. Among adults with obesity, no difference in NAION risk was observed between GLP-1s and other weight-loss medications.
In an analysis limiting the GLP-1 group to semaglutide users, NAION risk was similar between the semaglutide and non-GLP-1 cohorts. Semaglutide users also had similar risk for NAION as adults using other GLP-1 receptor agonists. In an analysis limited to adults with confirmed ophthalmologic testing, no difference in NAION risk was observed between adults using a GLP-1 receptor agonist and those using other medications.
In the final sensitivity analysis, researchers replicated the study using the Stanford Healthcare research repository. No difference in NAION risk was observed between the GLP-1 group and those using non-GLP-1 medications.
The prevalence of NAION across the analyses ranged from 0.07% to 0.24%.
Trial needed to confirm findings
Providers and patients should be aware of possible adverse events with any medication, Klonoff said, but he believes that the findings provide strong evidence that GLP-1s do not increase NAION risk.
“Larger databases are often more convincing databases than smaller ones,” Klonoff said. “We compared our results with the Stanford database, and no significant risk turned up there either. No mechanism for this potential inflammatory complication was suggested in the ophthalmologists’ report, and drugs in this family have been shown to have an anti-inflammatory effect. Based on this feature of drugs in this family and the way the ophthalmologists’ study was conducted, it is even less likely that this rare form of inflammatory blindness is linked to the use of GLP-1 drugs.”
Klonoff said the analysis is retrospective in nature and a randomized controlled trial would provide stronger evidence. However, Klonoff added that a randomized controlled trial is unlikely unless more concerns regarding an increased risk for NAION among GLP-1 users are presented.
“There is not enough money in the world to pay for such a trial for every suspected complication of every drug,” Klonoff said. “Thus, we might never see a randomized controlled trial to look specifically for this side effect unless other investigators notice this relationship in their patients.”
For more information:
David C. Klonoff, MD, FACP, FRCP (Edin), Fellow AIMBE, can be reached at dklonoff@diabetestechnology.org.
Collapse
Click Here to Manage Email Alerts