A RECENT study has identified a potential link between the use of semaglutide, a glucagon-like peptide 1 receptor agonist (GLP-1 RA), and an increased risk of developing nonarteritic anterior ischemic optic neuropathy (NAION) in patients with type 2 diabetes (T2D) or those who are overweight or obese.
The retrospective matched cohort study used data from a centralized registry of patients evaluated by neuro-ophthalmologists at an academic institution between December 2017 and November 2023. The study included 16,827 patients with no prior history of NAION, who were propensity-matched based on various factors including sex, age, systemic hypertension, T2D, obstructive sleep apnea, obesity, hyperlipidemia, and coronary artery disease. The participants were divided into two groups: those prescribed semaglutide and those prescribed non-GLP-1 RA medications for managing either diabetes or weight. The cumulative incidence of NAION was assessed using the Kaplan-Meier method and a Cox proportional hazards regression model to account for potential confounding factors.
The results showed that 710 participants had T2D (194 prescribed semaglutide; 516 prescribed non-GLP-1 RA medications) and 979 were overweight or obese (361 prescribed semaglutide;618 prescribed non-GLP-1 RA weight-loss medications). In the T2D group, 17 NAION events were recorded in patients on semaglutide compared to 6 events in the non0GLP-1 RA group. The cumulative incidence of NAION over 36 months was significantly higher in the semaglutide group (8.9%) compared to the non-GLP-1 RA group (1.8%). The adjusted hazard ratio (HR) for NAION in semaglutide users was 4.28.
Similarly, in the overweight or obese group, 20 NAION events occurred in the semaglutide group compared to 3 events in the non-GLP-1 RA group. The cumulative incidence of NAION over 36 months was 6.7% for the semaglutide group versus 0.8% for the non-GLP-1 RA group. The adjusted HR for NAION in semaglutide users was 7.64.
The findings from this study suggest that there is a significant association between the prescription of semaglutide and the occurrence of NAION in patients with T2D and those who are overweight or obese. However, as this was an observational study, further research is needed to establish causality and understand the underlying mechanisms.
Aleksandra Zurowska, EMJ
Reference:
Hathaway JT et al. Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide. JAMA Ophthalmol. 2024 [Epub ahead of print].
