Semaglutide Associated With Modest Increased Risk of Nonarteritic Anterior Ischemic Optic Neuropathy
In a previous study, results showed that patients taking semaglutide could be at a higher risk of nonarteritic anterior ischemic optic neuropathy (NAION), causing blindness.
Results of a study published in JAMA Ophthalmology showed a modest increased risk of nonarteritic anterior ischemic optic neuropathy (NAION) for patients with type 2 diabetes who are using semaglutide. However, the investigators stated that further research into this area is needed.1
They stated that the study did not show that semaglutide could cause NAION, but it did show a potential link between the 2. | Image Credit: TEEREXZ | stock.adobe.com
In a statement issued by the American Academy of Ophthalmology and the North American Neuro-Ophthalmology Society2, the organizations discuss results of a previous study published in the same journal3, which showed that patients taking semaglutide could be at a higher risk of NAION, causing blindness. They stated that the study did not show that semaglutide could cause NAION, but it did show a potential link between the 2. Further, they identified that semaglutide could cause blurred vision, worsening of diabetic retinopathy, and macular complications.
In the current study, investigators analyzed data from 6 administrative claims and 8 electronic health records databases, including patients 18 years and older who were taking semaglutide, dulaglutide, exenatide, empagliflozin, sitagliptin, or glipizide. Data were gathered from December 1, 2017, to December 31, 2023, according to the study authors. The primary outcomes include NAION, which was identified by diagnostic codes.1
Of the data, 8 used active comparator cohorts and 10 were self-controlled case series, according to the investigators. Across data sets, there were approximately 37.1 million individuals with type 2 diabetes, with 810,390 being new semaglutide users, 326,282 being dulaglutide, 25,936 being exenatide, 715,802 being empagliflozin, 493,563 being sitagliptin, and 832,295 being glipizide. According to the study authors, the sensitive definition included “1 ischemic optic neuropathy diagnosis code,” and the specific definition included “second confirmatory ischemic optic neuropathy diagnosis code within 90 days.”1
For new semaglutide users, NAION incidence was 7.1 and 4.2 per 100,000 persons, with incidence rates of 14.5 and 8.7 per 100,000 person years for sensitive and specific definitions, respectively. The risk for NAION with the sensitive had no difference between new semaglutide users, dulaglutide (meta-analysis HR, 0.93; 95% CI, 0.46-1.91; P = .57), empagliflozin (HR, 1.44; 95% CI, 0.78-2.68; P = .12), sitagliptin (HR, 1.30; 95% CI, 0.56-3.01; P = .27), and glipizide (HR, 1.23; 95% CI, 0.66-2.28; P = .25). Similarly, there was no difference for the specific definition between semaglutide and dulaglutide (HR, 1.28; 95% CI, 0.57-2.88; P = .55), sitagliptin (HR, 1.64; 95% CI, 0.69-3.90; P = .27), and glipizide (HR, 1.50; 95% CI, 0.70-3.21; P = .29).1
There was an increased risk of NAION for those who were new semaglutide users and empagliflozin users (HR, 2.27; 95% CI, 1.59-4.46; P = .02) when investigators used the specific definition. In the sensitivity analysis, there were 39,104 patients and 22,005 patients with NAION for the sensitive and specific definitions, respectively. There was an increased incidence associated with semaglutide for both definitions and an increased incidence rate for exenatide for the specific but not sensitive definitions.1
Investigators stated that “additional studies that incorporate ophthalmic risk factors or examine dose-dependent effects, eg, are needed to investigate a potential causal relationship between semaglutide and NAION.”1
