Risk of Retinal Vein Occlusion between Glucagon-Like Peptide-1 Receptor Agonists and Dipeptidyl Peptidase-4 Inhibitors in Type 2 Diabetes

Abstract

Objective

To evaluate whether glucagon-like peptide-1 receptor agonists (GLP-1RAs) are associated with reduced retinal vein occlusion (RVO) risk compared with dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with type 2 diabetes mellitus (T2DM).

Design

A multinational, retrospective cohort study.

Participants

Adults with T2DM newly prescribed GLP-1RAs or DPP-4 inhibitors between 2006 and 2023 were included in our analysis.

Methods

This study leveraged data from populations across 21 countries. Propensity score matching at a 1:1 ratio balanced age, sex, race, glycated hemoglobin (HbA1c), body mass index (BMI), estimated glomerular filtration rate, medications, and comorbidities between GLP-1RA and DPP4 inhibitor users.

Main Outcomes Measures

We observed the occurrence of incident RVO and branch RVO (BRVO) in the overall population and in subpopulations stratified by age, sex, race, GLP-1RA type, baseline HbA1c, BMI, and diabetes duration.

Results

Among 79 486 matched participants, GLP-1RA use is associated with a lower risk of RVO (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.54–0.98) and BRVO (HR, 0.62; 95% CI, 0.41–0.95) over 5 years compared with DPP-4 inhibitor use. This association is consistent among patients aged ≥50 years, Blacks, those prescribed human-analog GLP-1RAs, and those with baseline HbA1c ≥8%, BMI ≥30 kg/m², and diabetes duration ≥3 years.

Conclusions

Glucagon-like peptide-1 receptor agonist use was linked to reduced RVO and BRVO risks in patients with T2DM when compared with DPP-4 inhibitor use, particularly in high-risk populations, suggesting potential benefits of GLP-1RAs over DPP-4 inhibitors in managing ocular complications in T2DM.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.