{"title":"替西帕肽与其他抗肥胖药物对肥胖症患者眼部疗效的比较。","authors":"Yu-Nan Huang, Jo-Ching Chen, Pin-Hung Li, Min-Yen Hsu, Chun-Wen Cheng, Gideon Meyerowitz-Katz, Pen-Hua Su","doi":"10.1038/s43856-025-01066-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Obesity affects over one billion people worldwide and is associated with ocular complications, yet comparative effects of newer anti-obesity medications on eye health remain poorly understood. We examine ocular health outcomes among individuals with obesity receiving Tirzepatide, Semaglutide, Phentermine/Topiramate, Naltrexone/Bupropion, or Phentermine monotherapy.</p><p><strong>Methods: </strong>This propensity-score matched cohort study analyzed TriNetX US network data from November 2023 through April 2025. The study included matched pairs of obese individuals with a BMI ≥ 27 kg/m², comparing ocular outcomes between different anti-obesity medications. Primary outcomes included cataracts, oculomotor binocular dysfunction, visual disturbances, dry eye disease, ametropic accommodative dysfunction, and visual issues with blindness, assessed through Cox proportional hazards models with Bonferroni correction. Sensitivity analyses included BMI ≥ 30 kg/m² populations, subgroup stratification by clinical characteristics, and negative control outcomes to assess residual bias.</p><p><strong>Results: </strong>Here, we show that among 25,060 matched pairs comparing Tirzepatide with Semaglutide, no differences emerge across ocular outcomes. When compared with Naltrexone/Bupropion, Tirzepatide users show lower rates of cataracts (HR 0.46, 95% CI 0.23-0.92, p = 0.025) and oculomotor dysfunction (HR 0.31, 95% CI 0.16-0.60, p = 2.3 × 10<sup>-4</sup>). Semaglutide demonstrates similar patterns. Both medications show favorable profiles for visual disturbances, with Tirzepatide demonstrating lower rates versus Phentermine (HR 0.45, 95% CI 0.31-0.68, p = 7 × 10<sup>-5</sup>). Sensitivity analyses in the BMI ≥ 30 kg/m² population yield consistent results.</p><p><strong>Conclusions: </strong>Newer anti-obesity medications demonstrate differential associations with ocular outcomes compared to traditional agents. These findings may inform clinical decision-making regarding medication selection in obesity management, though prospective studies remain necessary to establish causal relationships.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"5 1","pages":"329"},"PeriodicalIF":5.4000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12316913/pdf/","citationCount":"0","resultStr":"{\"title\":\"Comparative ocular outcomes of tirzepatide versus other anti-obesity medications in people with obesity.\",\"authors\":\"Yu-Nan Huang, Jo-Ching Chen, Pin-Hung Li, Min-Yen Hsu, Chun-Wen Cheng, Gideon Meyerowitz-Katz, Pen-Hua Su\",\"doi\":\"10.1038/s43856-025-01066-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Obesity affects over one billion people worldwide and is associated with ocular complications, yet comparative effects of newer anti-obesity medications on eye health remain poorly understood. We examine ocular health outcomes among individuals with obesity receiving Tirzepatide, Semaglutide, Phentermine/Topiramate, Naltrexone/Bupropion, or Phentermine monotherapy.</p><p><strong>Methods: </strong>This propensity-score matched cohort study analyzed TriNetX US network data from November 2023 through April 2025. The study included matched pairs of obese individuals with a BMI ≥ 27 kg/m², comparing ocular outcomes between different anti-obesity medications. Primary outcomes included cataracts, oculomotor binocular dysfunction, visual disturbances, dry eye disease, ametropic accommodative dysfunction, and visual issues with blindness, assessed through Cox proportional hazards models with Bonferroni correction. Sensitivity analyses included BMI ≥ 30 kg/m² populations, subgroup stratification by clinical characteristics, and negative control outcomes to assess residual bias.</p><p><strong>Results: </strong>Here, we show that among 25,060 matched pairs comparing Tirzepatide with Semaglutide, no differences emerge across ocular outcomes. When compared with Naltrexone/Bupropion, Tirzepatide users show lower rates of cataracts (HR 0.46, 95% CI 0.23-0.92, p = 0.025) and oculomotor dysfunction (HR 0.31, 95% CI 0.16-0.60, p = 2.3 × 10<sup>-4</sup>). Semaglutide demonstrates similar patterns. Both medications show favorable profiles for visual disturbances, with Tirzepatide demonstrating lower rates versus Phentermine (HR 0.45, 95% CI 0.31-0.68, p = 7 × 10<sup>-5</sup>). Sensitivity analyses in the BMI ≥ 30 kg/m² population yield consistent results.</p><p><strong>Conclusions: </strong>Newer anti-obesity medications demonstrate differential associations with ocular outcomes compared to traditional agents. These findings may inform clinical decision-making regarding medication selection in obesity management, though prospective studies remain necessary to establish causal relationships.</p>\",\"PeriodicalId\":72646,\"journal\":{\"name\":\"Communications medicine\",\"volume\":\"5 1\",\"pages\":\"329\"},\"PeriodicalIF\":5.4000,\"publicationDate\":\"2025-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12316913/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Communications medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1038/s43856-025-01066-4\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, RESEARCH & EXPERIMENTAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Communications medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1038/s43856-025-01066-4","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}
引用次数: 0
摘要
背景：肥胖影响着全球超过10亿人，并与眼部并发症有关，然而，新的抗肥胖药物对眼睛健康的比较效果仍然知之甚少。我们检查了接受替西帕肽、西马鲁肽、芬特明/托吡酯、纳曲酮/安非他酮或芬特明单药治疗的肥胖患者的眼健康结果。方法：这项倾向评分匹配的队列研究分析了TriNetX美国网络从2023年11月到2025年4月的数据。该研究包括BMI≥27 kg/m²的配对肥胖个体，比较不同抗肥胖药物对眼部的影响。主要结局包括白内障、动眼性双眼功能障碍、视力障碍、干眼病、屈光调节功能障碍和失明的视力问题，通过Bonferroni矫正的Cox比例风险模型进行评估。敏感性分析包括BMI≥30 kg/m²人群、临床特征亚组分层和阴性对照结果来评估残留偏倚。结果：在这里，我们显示25,060对配对的替西帕肽和西马鲁肽比较，眼部结果没有出现差异。与纳曲酮/安非他酮相比，替西帕肽使用者白内障发生率（HR 0.46, 95% CI 0.23-0.92, p = 0.025）和动眼肌功能障碍发生率（HR 0.31, 95% CI 0.16-0.60, p = 2.3 × 10-4）较低。Semaglutide也表现出类似的模式。两种药物都显示出良好的视力障碍，与芬特明相比，替西帕肽显示出更低的发生率（HR 0.45, 95% CI 0.31-0.68, p = 7 × 10-5）。BMI≥30 kg/m²人群的敏感性分析结果一致。结论：与传统药物相比，新型抗肥胖药物与眼部预后的相关性有所不同。这些发现可能为肥胖治疗中药物选择的临床决策提供信息，但仍需要前瞻性研究来建立因果关系。
Comparative ocular outcomes of tirzepatide versus other anti-obesity medications in people with obesity.
Background: Obesity affects over one billion people worldwide and is associated with ocular complications, yet comparative effects of newer anti-obesity medications on eye health remain poorly understood. We examine ocular health outcomes among individuals with obesity receiving Tirzepatide, Semaglutide, Phentermine/Topiramate, Naltrexone/Bupropion, or Phentermine monotherapy.
Methods: This propensity-score matched cohort study analyzed TriNetX US network data from November 2023 through April 2025. The study included matched pairs of obese individuals with a BMI ≥ 27 kg/m², comparing ocular outcomes between different anti-obesity medications. Primary outcomes included cataracts, oculomotor binocular dysfunction, visual disturbances, dry eye disease, ametropic accommodative dysfunction, and visual issues with blindness, assessed through Cox proportional hazards models with Bonferroni correction. Sensitivity analyses included BMI ≥ 30 kg/m² populations, subgroup stratification by clinical characteristics, and negative control outcomes to assess residual bias.
Results: Here, we show that among 25,060 matched pairs comparing Tirzepatide with Semaglutide, no differences emerge across ocular outcomes. When compared with Naltrexone/Bupropion, Tirzepatide users show lower rates of cataracts (HR 0.46, 95% CI 0.23-0.92, p = 0.025) and oculomotor dysfunction (HR 0.31, 95% CI 0.16-0.60, p = 2.3 × 10-4). Semaglutide demonstrates similar patterns. Both medications show favorable profiles for visual disturbances, with Tirzepatide demonstrating lower rates versus Phentermine (HR 0.45, 95% CI 0.31-0.68, p = 7 × 10-5). Sensitivity analyses in the BMI ≥ 30 kg/m² population yield consistent results.
Conclusions: Newer anti-obesity medications demonstrate differential associations with ocular outcomes compared to traditional agents. These findings may inform clinical decision-making regarding medication selection in obesity management, though prospective studies remain necessary to establish causal relationships.
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