Hsu Alan Y, Kuo Hou-Ting, Wang Yu-Hsun, Lin Chun-Ju, Shao Yi-Ching, Chiang Chun-Chi, Hsia Ning-Yi, Lai Chun-Ting, Tseng Hsin, Wu Bing-Qi, Chen Huan-Sheng, Tsai Yi-Yu, Hsu Min-Yen, Wei James Cheng-Chung
Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.
Department of General Medicine, China Medical University Hospital, Taichung, Taiwan.
JAMA Ophthalmol. 2025 May 1;143(5):400-407. doi: 10.1001/jamaophthalmol.2025.0349.
Recent studies have suggested an association between nonarteritic anterior ischemic optic neuropathy (NAION) with semaglutide usage. However, the limitations of those analyses warrant further investigation, given the frequency of use of these medications in people with and without diabetes.
To investigate the association between semaglutide use and the risk of NAION among patients with diabetes.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the TriNetX database between October 1, 2019, and December 31, 2023, to identify patients with diabetes with no history of NAION who were prescribed semaglutide. The semaglutide cohort was compared with a control group of randomly selected patients with diabetes who were prescribed non-glucagonlike peptide 1 (non-GLP-1) receptor agonist (RA) antidiabetic medications. The data analysis for this study was performed on September 1, 2024.
Semaglutide history, identified using diagnostic codes.
Cumulative incidence and (HR) hazard ratio of NAION.
A total of 3 344 205 patients with diabetes were included in this study. Regarding the diabetes cohort, a total of 174 584 patients with diabetes who received semaglutide (mean [SD] age, 58.3 [12.5] years; 90 427 female [51.8%]; 71 739 male [41.1%]) and 174 584 patients with diabetes who received non-GLP-1 RA medications (mean [SD] age, 58.2 [14.3] years; 90 475 female [51.82%]; 71 989 male [41.24%]) were recruited. Patients with diabetes taking semaglutide exhibited an absence of NAION risk at the 1-month (HR, 2.99; 95% CI, 0.31-28.75), 3-month (HR, 1.33; 95% CI, 0.30-5.93), 6-month (HR, 1.79; 95% CI, 0.60-5.35), and 1-year (HR, 1.94; 95% CI: 0.93-4.02) time points after the index date. However, those taking semaglutide were found to have an increased risk for NAION at the 2-year (HR, 2.39; 95% CI, 1.37-4.18), 3-year (HR, 2.44; 95% CI, 1.44-4.12), and 4-year (HR, 2.05; 95% CI, 1.26-3.34) time points from the index date. Increased risk for NAION was also noted in patients with diabetes and concomitant hypertension who were taking semaglutide (HR, 2.42; 95% CI, 1.19-4.92). An increased NAION risk was also observed among patients with diabetes who had a history of Ozempic (Novo Nordisk) use or stand-alone Ozempic (Novo Nordisk) prescription history.
Results of this cohort study suggest that semaglutide use was associated with an increased risk of NAION in patients with diabetes. However, the study's retrospective design presents limitations, as it can only infer associations rather than establish causality; further studies are needed.
最近的研究表明，司美格鲁肽的使用与非动脉炎性前部缺血性视神经病变（NAION）之间存在关联。然而，鉴于这些药物在糖尿病患者和非糖尿病患者中的使用频率，这些分析的局限性值得进一步研究。
研究糖尿病患者使用司美格鲁肽与发生NAION风险之间的关联。
设计、设置和参与者：这项队列研究使用了TriNetX数据库在2019年10月1日至2023年12月31日期间的数据，以确定无NAION病史且被处方使用司美格鲁肽的糖尿病患者。将司美格鲁肽队列与随机选择的被处方使用非胰高血糖素样肽1（非GLP-1）受体激动剂（RA）抗糖尿病药物的糖尿病患者对照组进行比较。本研究的数据分析于2024年9月1日进行。
使用诊断代码确定的司美格鲁肽用药史。
NAION的累积发病率和风险比（HR）。
本研究共纳入3344205例糖尿病患者。在糖尿病队列中，共招募了174584例接受司美格鲁肽治疗的糖尿病患者（平均[标准差]年龄，58.3[12.5]岁；女性90427例[51.8%]；男性71739例[41.1%]）和174584例接受非GLP-1 RA药物治疗的糖尿病患者（平均[标准差]年龄，58.2[14.3]岁；女性90475例[51.82%]；男性71989例[41.24%]）。在索引日期后的1个月（HR，2.99；95%CI，0.31-28.75）、3个月（HR，1.33；95%CI，0.30-5.93）、6个月（HR，1.79；95%CI，0.60-5.35）和1年（HR，1.94；95%CI：0.93-4.02）时间点，使用司美格鲁肽的糖尿病患者未表现出NAION风险。然而，在索引日期后的2年（HR，2.39；95%CI，1.37-4.18）、3年（HR，2.44；95%CI，1.44-4.12）和4年（HR，2.05；95%CI，1.26-3.34）时间点，发现使用司美格鲁肽的患者发生NAION的风险增加。在同时患有糖尿病和高血压且使用司美格鲁肽的患者中，也注意到NAION风险增加（HR，2.42；95%CI，1.19-4.92）。在有使用Ozempic（诺和诺德公司）病史或单独使用Ozempic（诺和诺德公司）处方史的糖尿病患者中也观察到NAION风险增加。
这项队列研究的结果表明，糖尿病患者使用司美格鲁肽与NAION风险增加有关。然而，该研究的回顾性设计存在局限性，因为它只能推断关联而不能确立因果关系；需要进一步研究。
