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IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2025-02-25 DOI:10.1016/j.ajo.2025.02.025

Nadia J. Abbass , Raya Nahlawi , Jacqueline K. Shaia , Kevin C. Allan , David C Kaelber , Katherine E. Talcott , Rishi P. Singh

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引用次数: 0

摘要

目的：GLP-1 受体激动剂（GLP-1RA）与非动脉炎性前部缺血性视神经病变（NAION）之间的关系仍不清楚。鉴于非动脉炎性前部缺血性视神经病变（NAION）会导致衰弱的后遗症，以及 GLP-1RA 使用量的快速增长，进一步研究这种潜在关系至关重要。本研究旨在确定GLP-1RA处方患者发生NAION和缺血性视神经病变（ION）的风险：设计：回顾性匹配队列研究：设计：回顾性匹配队列研究：年龄≥12 岁、患有 2 型糖尿病 (T2DM)、超重或肥胖（高 BMI）、至少接受过一次眼科或神经科检查的患者。在 T2DM 患者中，约有 120,000 名开具了赛马鲁肽处方的患者和 220,000 名开具了任何 GLP-1RA 处方的患者与匹配的 T2DM 对照组进行了比较。在高体重指数患者中，约有 58,000 人服用了塞马鲁肽，66,000 人服用了任何一种 GLP-1RA，并与匹配的对照组进行了比较：方法：将处方为塞马鲁肽或任何一种 GLP-1RA 的患者与服用非 GLP-1RA 药物的患者进行比较。根据各种人口统计学和风险因素对人群进行倾向匹配（1:1），以平衡基线队列：NAION和ION的累积发病率和风险。报告风险比 (RR) 及 95% 置信区间 (CI)，显著性定义为 CI 1.1：与匹配的 T2DM 对照组相比，T2DM 患者在 5 年后发生 NAION（RR = 0.7，95% CI：0.523-0.937）和 ION（RR = 0.788，95% CI：0.609-1.102）的风险没有显著增加。同样，与对照组相比，服用任何一种 GLP-1RA 的 T2DM 患者发生 NAION（RR = 0.887，95% CI：0.735-1.071）或 ION（RR = 0.969，95% CI：0.813-1.154）的风险也没有明显差异。此外，在高体重指数组中，未发现处方为塞马鲁肽或任何 GLP-1RA 的患者出现上述任何一种结果的风险增加。服用塞马鲁肽的 T2DM 患者发生 NAION 和 ION 的 5 年累积风险分别为 0.065% 和 0.08%。对于那些BMI指数较高的患者，服用塞马鲁肽两年后发生NAION和ION的风险分别为0.038%和0.404%：与 T2DM 或高 BMI 对照组相比，服用 semaglutide 或 GLP-1RAs 的患者发生 NAION 或 ION 的风险没有明显增加。

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The Effect of Semaglutide and GLP-1 RAs on Risk of Nonarteritic Anterior Ischemic Optic Neuropathy

PURPOSE

The association between GLP-1 receptor agonists (GLP-1RA) and nonarteritic anterior ischemic optic neuropathy (NAION) remains unclear. Given the debilitating sequelae of NAION and rapid increase of GLP-1RA use, further research is essential to investigate this potential relationship. This study seeks to determine the risk of NAION and ischemic optic neuropathy (ION) in patients prescribed GLP-1RAs.

DESIGN

Retrospective matched cohort study.

SETTING

TriNetX United States collaborative network.

PARTICIPANTS

Patients ≥12 years old with type 2 diabetes (T2DM) and considered overweight or obese (high BMI), with at least one ophthalmology or neurology visit. Among T2DM patients, approximately 120,000 patients with a semaglutide prescription and 220,000 prescribed any GLP-1RA were compared to matched T2DM controls. Among high BMI patients, approximately 58,000 on semaglutide and 66,000 on any GLP-1RA were compared to matched controls.

METHODS

Patients prescribed semaglutide or any GLP-1RA were compared with those on non-GLP-1RA medications. Populations were propensity matched (1:1) on various demographic and risk factors to balance baseline cohorts.

MAIN OUTCOMES AND MEASURES

Cumulative incidence and risk of NAION and ION. Risk ratios (RR) with 95% confidence intervals (CI) were reported, with significance defined as CI <0.9 or > 1.1.

RESULTS

In T2DM patients prescribed semaglutide, the risk of NAION (RR = 0.7, 95% CI: 0.523-0.937) and ION (RR = 0.788, 95% CI: 0.609-1.102) after 5 years was not significantly increased compared to matched T2DM controls. Similarly, T2DM patients on any GLP-1RA demonstrated no significant difference in the risk of NAION (RR = 0.887, 95% CI: 0.735-1.071) or ION (RR = 0.969, 95% CI: 0.813-1.154) compared to controls. Furthermore, no increased risk of either outcome was found in the high BMI groups prescribed semaglutide or any GLP-1RA. The cumulative 5-year risk of NAION and ION in T2DM patients on semaglutide was 0.065% and 0.08%, respectively. In those with high BMI prescribed semaglutide, the risk of NAION and ION after 2 years was 0.038% and 0.404%, respectively.

CONCLUSIONS

There was no significant increase in risk of NAION or ION in patients taking semaglutide or GLP-1RAs compared to T2DM or high BMI controls.

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.