司美格鲁肽和胰高血糖素样肽-1受体激动剂对非动脉性前部缺血性视神经病变风险的影响。
The Effect of Semaglutide and GLP-1 RAs on Risk of Nonarteritic Anterior Ischemic Optic Neuropathy.
作者信息
Abbass Nadia J, Nahlawi Raya, Shaia Jacqueline K, Allan Kevin C, Kaelber David C, Talcott Katherine E, Singh Rishi P
机构信息
From the Case Western Reserve University School of Medicine (N.J.A., R.N., J.K.S.), Cleveland, Ohio, USA; Center for Ophthalmic Bioinformatics (N.J.A., R.N., J.K.S., K.E.T., R.P.S.), Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Cleveland Clinic Cole Eye Institute (K.C.A., K.E.T., R.P.S.), Cleveland, Ohio, USA.
出版信息
Am J Ophthalmol. 2025 Jun;274:24-31. doi: 10.1016/j.ajo.2025.02.025. Epub 2025 Feb 25.
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.
目的
胰高血糖素样肽-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）之间的关联仍不明确。鉴于NAION会导致使人衰弱的后遗症，且GLP-1RA的使用迅速增加，进一步研究以调查这种潜在关系至关重要。本研究旨在确定使用GLP-1RA的患者发生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。
设置
TriNetX美国协作网络。
参与者
年龄≥12岁的2型糖尿病（T2DM）患者，被认为超重或肥胖（高体重指数），且至少有一次眼科或神经科就诊记录。在T2DM患者中，将约120,000例使用司美格鲁肽处方的患者和220,000例使用任何GLP-1RA的患者与匹配的T2DM对照进行比较。在高体重指数患者中，将约58,000例使用司美格鲁肽的患者和66,000例使用任何GLP-1RA的患者与匹配的对照进行比较。
方法
将使用司美格鲁肽或任何GLP-1RA的患者与使用非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评分匹配（1:1），以平衡基线队列。
主要结局和指标
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<0.9或>1.1。
结果
在使用司美格鲁肽的T2DM患者中，与匹配的T2DM对照相比，5年后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，使用任何GLP-1RA的T2DM患者在NAION（RR = 0.887，95%CI：0.735 - 1.071）或ION（RR = 0.969，95%CI：0.813 - 1.154）风险方面没有显著差异。此外，在使用司美格鲁肽或任何GLP-1RA的高体重指数组中，未发现任何一种结局的风险增加。使用司美格鲁肽的T2DM患者中，NAION和ION的5年累积风险分别为0.065%和0.08%。在高体重指数且使用司美格鲁肽的患者中，2年后NAION和ION的风险分别为0.038%和0.404%。
结论
与T2DM或高体重指数对照相比，使用司美格鲁肽或GLP-1RA的患者发生NAION或ION的风险没有显著增加。
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