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Semaglutide Linked to NAION Risk
A retrospective database study found a low absolute incidence but higher relative hazard of ischemic optic neuropathy following semaglutide initiation.
To evaluate the long-term risk of nonarteritic anterior ischemic optic neuropathy (NAION) in patients with diabetes receiving semaglutide compared to those on non-GLP-1 RA antidiabetic medications.
Key Findings:
Semaglutide use was not associated with a statistically significant increase in NAION risk through 1 year of follow-up.
Elevated relative risk of NAION emerged at 2 years and persisted through 4 years.
NAION occurred in 45 semaglutide-treated patients (0.026%) compared to 29 patients on non-GLP-1 RA therapies (0.017%).
Hazard ratio for NAION with semaglutide was 2.22 compared to non-GLP-1 RA use, indicating approximately twice the risk.
Increased risk observed in patients aged 40-64, female patients, White patients, and those with hypertension.
Interpretation:
The study suggests an elevated risk of NAION associated with semaglutide use in diabetic patients, particularly in specific subgroups, but findings are preliminary and require further investigation through well-designed studies.
Inability to verify medication adherence and potential residual confounding.
ICD-10 diagnostic code for NAION may not be fully specific, risking outcome misclassification.
Small event counts in subgroup analyses limit the robustness of findings.
Conclusion:
The study indicates an association between semaglutide use and increased NAION risk in diabetic patients, warranting further observational studies to confirm these findings.
