Patients who take semaglutide (Ozempic, Wegovy) for type 2 diabetes or obesity could potentially be at risk for nonarteritic anterior ischemic optic neuropathy (NAION), according to a new observational study.
Published online in JAMA Ophthalmology,1 it is the first report of an association between the weight-loss drug and NAION.
But the authors noted the study does not inform a mechanism to link semaglutide, a glucagon-like peptide 1 receptor agonist (GLP-1 RA), to NAION.
NAION “is the second most common form of optic neuropathy and a significant cause of blindness among adults”, the study authors wrote.
Our anecdotal clinical experience motivated us to study whether semaglutide is associated with an increased risk of developing NAION…
“Weekly new-to-brand prescriptions in the United States of these and other … (GLP-1 RA) drugs increased by approximately 60 per cent from 2021 to 2023,” the researchers said.
“Our anecdotal clinical experience motivated us to study whether semaglutide is associated with an increased risk of developing NAION.”
The retrospective matched cohort study involved 16,827 patients evaluated by neuro-ophthalmologists between 2017 and 2023. Of that group, 710 people had type 2 diabetes, and 979 were overweight or obese. Participants were on average 59 years old in the diabetes group and 47 years old in the other group; the majority of both groups were female.
Clinicians prescribed semaglutide to 194 patients with type 2 diabetes and to 361 patients who were overweight or obese. They prescribed non-GLP-1 RA antidiabetic medications to 516 patients in the diabetes group and non-GLP-1 RA weight-loss medications to 618 people from the other group.
Over a mean follow-up of nearly three years, patients with diabetes on semaglutide had more than a fourfold higher risk for developing NAION compared with patients not on a GLP-1 agonist (HR 4.28, 95% CI 1.62-11.29, P<0.001).
Those prescribed semaglutide for overweight or obesity had an over sevenfold higher risk for NAION (HR 7.64, 95% CI 2.21-26.36, P<0.001).
As with any drug, the study authors noted, “therapeutic benefits are inseparable from adverse effects”, and prior research has linked semaglutide with higher risks of retinopathy exacerbation, progression of proliferative retinopathy, and new-onset macular oedema. But this is the first time semaglutide has been linked to NAION, according to the researchers.
Reference
Hathaway, J.T., Shah, M.P., Hathaway, D.B., et al., Risk of nonarteritic anterior ischemic optic neuropathy in patients prescribed semaglutide. JAMA Ophthalmol. Published online July 03, 2024. DOI: 10.1001/jamaophthalmol.2024.2296.