Data and Timing-Related Concerns About Semaglutide and NAION Risk

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Heberer et al used a target trial emulation with overlap weighting to compare NAION risk among US veterans initiating semaglutide or an SGLT2 inhibitor.
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Among SGLT2 inhibitor initiators, the at-risk count fell by 3,748 from day 0 to day 182.5, while reported events and censoring accounted for 545 patients.
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The letter noted that 3,203 patients, approximately 3.5% of the SGLT2 inhibitor cohort, were not accounted for in the risk pool during the first 6 months.
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The Kaplan-Meier curves reportedly began to separate at approximately 1 year, raising concern that a single hazard ratio of 2.33 may not reflect changing risk over time.
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The letter asked whether the hazard ratio differed between the first treatment year and later follow-up and noted that NAION coding had a reported positive predictive value of approximately 74.5%.

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