Kumar Madhukar, Abbass Nadia J, Russell Matthew W, Das Nikhil, Singh Rishi P, Talcott Katherine E
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
Eye (Lond). 2025 May 10. doi: 10.1038/s41433-025-03818-x.
BACKGROUND/OBJECTIVES: Medication assisted weight loss for treatment of obesity has rapidly increased. The effect of this treatment with phentermine on diabetic retinopathy (DR) is underexplored.
SUBJECTS/METHODS: Retrospective cohort study. The U.S. Collaborative Network of the TriNetX platform was queried for patients diagnosed with overweight and obesity and prescription of phentermine. Patients were propensity score matched across baseline demographics and systemic risk factors at the time of medication initiation and compared to those diagnosed with overweight and obesity without usage of weight loss medications, identifying 26,611 patients per cohort after propensity score matching. Risk ratios (RR) of incident DR and related diagnoses or procedural codes found after the medication initiation date for pertinent disease worsening and treatment metrics were assessed.
Phentermine usage was found to be associated with reduced future risk of a new diagnosis of DR with macular oedema (RR 0.462; (95% CI 0.372-0.573), P < 0.001), mild non-proliferative diabetic retinopathy (NPDR) (RR 0.621 (0.508, 0.760), P < 0.001), moderate NPDR (RR 0.567 (0.402, 0.799), P < 0.001), severe NPDR (RR 0.477 (0.233, 0.981), P = 0.003), proliferative diabetic retinopathy (PDR) (RR 0.451 (0.323, 0.629), P < 0.001), vitreous haemorrhage (RR 0.347 (0.200, 0.602), P < 0.001), need for intravitreal anti-VEGF injection (RR: 0.530 (0.354, 0.793), P < 0.001).
The present analysis suggests that phentermine usage is associated with a decreased risk of diabetic macular oedema, NPDR, PDR, and worsening events.
背景/目的：药物辅助减肥治疗肥胖症的应用迅速增加。但这种使用苯丁胺治疗对糖尿病视网膜病变（DR）的影响尚未得到充分研究。
受试者/方法：回顾性队列研究。通过美国TriNetX平台协作网络查询诊断为超重和肥胖且开具了苯丁胺处方的患者。在开始用药时，根据倾向得分对患者的基线人口统计学和全身风险因素进行匹配，并与未使用减肥药物诊断为超重和肥胖的患者进行比较，倾向得分匹配后每个队列确定26,611名患者。评估用药开始日期后发现的相关疾病恶化和治疗指标的新发DR及相关诊断或程序代码的风险比（RR）。
发现使用苯丁胺与新发伴有黄斑水肿的DR（RR 0.462；（95%可信区间0.372 - 0.573），P < 0.001）、轻度非增殖性糖尿病视网膜病变（NPDR）（RR 0.621（0.508，0.760），P < 0.001）、中度NPDR（RR 0.567（0.402，0.799），P < 0.001）、重度NPDR（RR 0.477（0.233，0.981），P = 0.003）、增殖性糖尿病视网膜病变（PDR）（RR 0.451（0.323，0.629），P < 0.001）、玻璃体积血（RR 0.347（0.200，0.602），P < 0.001）、玻璃体内抗VEGF注射需求（RR：0.530（0.354，0.793），P < 0.001）的未来风险降低相关。
本分析表明，使用苯丁胺与糖尿病黄斑水肿、NPDR、PDR及病情恶化事件的风险降低相关。
