TOPLINE
Among adults with type 2 diabetes, GLP-1 receptor agonists (RAs) were associated with a higher incidence of ischemic optic neuropathy (ION) at 18 months than SGLT2 inhibitors and DPP-4 inhibitors, an analysis of US insurance claims data showed. The absolute risk was low, however, and limitations in the design of the study mean the results should be interpreted with caution, the researchers said.
METHODOLOGY
- To examine the risk for ION in patients taking diabetes medications, the researchers analyzed data from the Merative MarketScan Commercial Claims and Encounters database from January 2017 to December 2022.
- Participants included adults aged 18-65 years with type 2 diabetes who initiated a GLP-1 RA (n = 161,489), an SGLT2 inhibitor (n = 122,114), or a DPP-4 inhibitor (n = 86,047).
- The primary endpoint was incident ION, as a proxy for nonarteritic anterior ION (NAION), during 18 months of follow-up.
- The researchers used propensity scores to balance more than 80 baseline covariates.
TAKEAWAY
- GLP-1 RA vs SGLT2 inhibitor users had an 18-month ION risk of 8.5 vs 5.5 cases per 10,000 patients, yielding risk difference of three cases (95% CI, 0.4-5.7) per 10,000 patients.
- In comparison with DPP-4 inhibitor users, GLP-1 RA users had an ION risk of 4.2 vs 7.8 cases per 10,000 patients — a risk difference of 3.6 cases (95% CI, 1.1-6.1) per 10,000 patients.
- Among GLP-1 RA users, 69 of 81 ION events (85.2%) occurred in those who were older than 50 years, and 57 of 81 events (70.3%) occurred in men despite women comprising 55% of GLP-1 RA initiators overall.
IN PRACTICE
“Despite the very low absolute risk for ION, the rapidly expanding use of GLP-1 RAs in patients with and without [type 2 diabetes] increases the clinical and public health importance of any potential association,” the researchers reported. “If causal, the findings may be most relevant to older adults and males, who have a higher baseline risk for ION. At the same time, any potential safety signal should be weighed against the established cardiometabolic benefits of GLP-1 RAs.”
SOURCE
Chintan V. Dave, PharmD, PhD, with Rutgers University in New Brunswick, New Jersey, was the corresponding author for the study, which was published online on July 13 in the Annals of Internal Medicine.
LIMITATIONS
The results should be interpreted with caution because factors such as the severity and duration of type 2 diabetes could have influenced which treatment patients received. The researchers lacked information about several important confounders such as BMI, smoking history, and A1c. In addition, the investigators relied on the diagnostic code for ION as a proxy for NAION.
DISCLOSURES
The National Institutes of Health was the primary source of funding for the study.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.