Abstract: A brand new examine reveals that sufferers prescribed semaglutide (Ozempic or Wegovy) for diabetes or weight reduction have a better threat of creating NAION, a probably blinding eye situation.
Diabetic sufferers on semaglutide have been over 4 instances extra more likely to be identified with NAION, whereas obese sufferers have been over seven instances extra doubtless. The findings recommend the necessity for cautious discussions between sufferers and medical doctors about this threat. NAION stays a uncommon however critical situation with no efficient therapies.
Key Information:
- Semaglutide customers with diabetes are over 4 instances extra more likely to develop NAION.
- Obese sufferers on semaglutide have a sevenfold elevated threat of NAION.
- NAION is a uncommon situation with no present efficient therapies.
Supply: Mass Common
A brand new examine led by investigators from Mass Eye and Ear discovered that sufferers prescribed semaglutide (as Ozempic or Wegovy) for diabetes or weight reduction had a better threat of getting a probably blinding eye situation referred to as NAION than related sufferers who had not been prescribed these medication.
Notably, the examine discovered folks with diabetes who had been prescribed semaglutide by their doctor after which crammed the prescription have been greater than 4 instances extra more likely to be identified with NAION. Those that have been obese or had weight problems and prescribed this drug have been greater than seven instances extra more likely to get the analysis.
The examine, which was led by Joseph Rizzo, MD, director of the Neuro-Ophthalmology Service at Mass Eye and Ear and the Simmons Lessell Professor of Ophthalmology at Harvard Medical College, printed July 3rd in JAMA Ophthalmology.
“The usage of these medication has exploded all through industrialized nations and so they have offered very vital advantages in some ways, however future discussions between a affected person and their doctor ought to embody NAION as a possible threat,” stated Rizzo, the examine’s corresponding writer.
“You will need to admire, nevertheless, that the elevated threat pertains to a dysfunction that’s comparatively unusual.”
NAION is comparatively uncommon, occurring as much as 10 out of 100,000 folks within the normal inhabitants. NAION is the second-leading explanation for optic nerve blindness (second solely to glaucoma) and it’s the most typical explanation for sudden optic nerve blindness. NAION is regarded as attributable to diminished blood movement to the optic nerve head, with the consequence of everlasting visible loss in a single eye.
In keeping with Rizzo, the visible loss attributable to NAION is painless and will progresses over many days earlier than stabilizing, and there’s comparatively little potential for enchancment. There are at the moment no efficient therapies for NAION.
The impetus for the examine occurred within the late summer season of 2023 when Rizzo, a resident (examine co-author Seyedeh Maryam Zekavat, MD, PhD) and different Mass Eye and Ear neuro-ophthalmologists observed a disturbing development — three sufferers of their apply had been identified with imaginative and prescient loss from this comparatively unusual optic nerve illness in only one week. The physicians noticed all three have been taking semaglutide.
This anecdotal recognition led the Mass Eye and Ear analysis staff to run a backward-looking evaluation of their affected person inhabitants to see if they may establish a hyperlink between this illness and these medication, which had been surging in reputation.
Semaglutide was developed to deal with sort 2 diabetes. The drug encourages weight reduction, and its use has snowballed since its launch as Ozempic for diabetes in 2017. The drug was additionally permitted for weight administration, branded as Wegovy, and launched in 2021.
The researchers analyzed the information of greater than 17,000 Mass Eye and Ear sufferers handled over the six years since Ozempic was launched and divided the sufferers in those that have been identified with both diabetes or obese/ weight problems.
The researchers in contrast sufferers who had obtained prescriptions for semaglutide in comparison with these taking different diabetes or weight reduction medication. Then, they analyzed the speed of NAION diagnoses within the teams, which revealed the numerous threat will increase.
There are a number of limitations to the examine. Mass Eye and Ear sees an unusually excessive variety of folks with uncommon eye illnesses, the examine inhabitants is majority white, and the variety of NAION instances seen over the six-year examine interval is comparatively small. With small case numbers, statistics can change rapidly, Rizzo famous.
The researchers additionally couldn’t decide if the sufferers truly took their remedy or in the event that they began after which stopped taking semaglutide sooner or later and the way this may need impacted their threat.
Importantly, the examine doesn’t show causality, and the researchers don’t know why or how this affiliation exists, and why there was a distinction reported in diabetic and obese teams.
“Our findings must be seen as being vital however tentative, as future research are wanted to look at these questions in a a lot bigger and extra numerous inhabitants,” Rizzo stated.
“That is info we didn’t have earlier than and it must be included in discussions between sufferers and their medical doctors, particularly if sufferers produce other identified optic nerve issues like glaucoma or if there’s preexisting vital visible loss from different causes.”
Authorship: Along with Rizzo and Zekavat, different Mass Common Brigham co-authors embody Jimena Tatiana Hathaway, MD, MPH (MEE); Madhura P. Shah, BS (MEE); David B. Hathaway, MD (BWH); Drenushe Krasniqi, BA (MEE); John W. Gittinger Jr, MD (MEE); Dean Cestari, MD (MEE); Robert Mallery, MD (MEE); Bardia Abbasi, MD (MEE); Marc Bouffard, MD (MEE); Bart Ok. Chwalisz, MD (MEE) and Tais Estrela, MD (MEE).
Disclosures: No conflicts of curiosity reported.
Funding: This work was funded partially by a grant from Analysis to Forestall Blindness.
About this imaginative and prescient and neuropharmacology analysis information
Writer: Tim Sullivan
Supply: Mass Common
Contact: Tim Sullivan – Mass Common
Picture: The picture is credited to Neuroscience Information
Authentic Analysis: Closed entry.
“Threat of Nonarteritic Anterior Ischemic Optic Neuropathy in Sufferers Prescribed Semaglutide” by Joseph Rizzo et al. JAMA Opthalmology
Summary
Threat of Nonarteritic Anterior Ischemic Optic Neuropathy in Sufferers Prescribed Semaglutide
Significance
Anecdotal expertise raised the chance that semaglutide, a glucagon-like peptide 1 receptor agonist (GLP-1 RA) with quickly growing use, is related to nonarteritic anterior ischemic optic neuropathy (NAION).
Goal
To analyze whether or not there’s an affiliation between semaglutide and threat of NAION.
Design, Setting, and Members
In a retrospective matched cohort examine utilizing information from a centralized information registry of sufferers evaluated by neuro-ophthalmologists at 1 educational establishment from December 1, 2017, by means of November 30, 2023, a seek for Worldwide Statistical Classification of Ailments and Associated Health Issues, Tenth Revision code H47.01 (ischemic optic neuropathy) and textual content search yielded 16 827 sufferers with no historical past of NAION.
Propensity matching was used to evaluate whether or not prescribed semaglutide was related to NAION in sufferers with sort 2 diabetes (T2D) or obese/weight problems, in every case accounting for covarying elements (intercourse, age, systemic hypertension, T2D, obstructive sleep apnea, weight problems, hyperlipidemia, and coronary artery illness) and contraindications to be used of semaglutide.
The cumulative incidence of NAION was decided with the Kaplan-Meier technique and a Cox proportional hazards regression mannequin adjusted for potential confounding comorbidities. Knowledge have been analyzed from December 1, 2017, by means of November 30, 2023.
Exposures
Prescriptions for semaglutide vs non–GLP-1 RA medicines to handle both T2D or weight.
Important Outcomes and Measures
Cumulative incidence and hazard ratio of NAION.
Outcomes
Amongst 16 827 sufferers, 710 had T2D (194 prescribed semaglutide; 516 prescribed non–GLP-1 RA antidiabetic medicines; median [IQR] age, 59 [49-68] years; 369 [52%] feminine) and 979 have been obese or overweight (361 prescribed semaglutide; 618 prescribed non–GLP-1 RA weight-loss medicines; median [IQR] age, 47 [32-59] years; 708 [72%] feminine). Within the inhabitants with T2D, 17 NAION occasions occurred in sufferers prescribed semaglutide vs 6 within the non–GLP-1 RA antidiabetes cohort.
The cumulative incidence of NAION for the semaglutide and non–GLP-1 RA cohorts over 36 months was 8.9% (95% CI, 4.5%-13.1%) and 1.8% (95% CI, 0%-3.5%), respectively. A Cox proportional hazards regression mannequin confirmed increased threat of NAION for sufferers receiving semaglutide (hazard ratio [HR], 4.28; 95% CI, 1.62-11.29); P < .001). Within the inhabitants of sufferers who have been obese or overweight, 20 NAION occasions occurred within the prescribed semaglutide cohort vs 3 within the non–GLP-1 RA cohort.
The cumulative incidence of NAION for the semaglutide vs non–GLP-1 RA cohorts over 36 months was 6.7% (95% CI, 3.6%-9.7%) and 0.8% (95% CI, 0%-1.8%), respectively. A Cox proportional hazards regression mannequin confirmed a better threat of NAION for sufferers prescribed semaglutide (HR, 7.64; 95% CI, 2.21-26.36; P < .001).
Conclusions and Relevance
This examine’s findings recommend an affiliation between semaglutide and NAION. As this was an observational examine, future examine is required to evaluate causality.
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