Nonarteritic Anterior Ischemic Optic Neuropathy Increased With Semaglutide

WEDNESDAY, Feb. 26, 2025 (HealthDay News) — For individuals with type 2 diabetes (T2D), semaglutide is associated with a modestly increased risk for nonarteritic anterior ischemic optic neuropathy (NAION), according to a study published online Feb. 20 in JAMA Ophthalmology.

Cindy X. Cai, M.D., from the Johns Hopkins School of Medicine in Baltimore, and colleagues conducted a retrospective study across 14 databases to examine the potential association between semaglutide and NAION. Adults with T2D taking semaglutide, other glucagon-like peptide 1 receptor agonists (GLP-1 RAs; dulaglutide and exenatide), or non-GLP-1 RA medications (empagliflozin, sitagliptin, and glipizide) from Dec. 1, 2017, to Dec. 31, 2023, were included. Of 37.1 million individuals with T2D, there were 810,390 new semaglutide users.

The researchers found that among semaglutide users, the incidence rate of NAION was 14.5 per 100,000 person-years. Using the sensitive NAION definition, the hazard ratio for NAION among new users of semaglutide was not different compared with that of the non-GLP-1 RA medications empagliflozin, sitagliptin, and glipizide. Using the specific definition, the risk was higher for semaglutide users compared with patients taking empagliflozin (hazard ratio, 2.27). The risk for NAION was increased in a self-controlled case series analysis of semaglutide exposure (meta-analysis incidence rate ratio, 1.32).

“In the absence of a known mechanism for this association, we urge clinicians to weigh the concern for an increased risk of a rare but potentially blinding eye condition with the many therapeutic benefits of semaglutide,” the authors write.

Several authors disclosed ties to industry.

Abstract/Full Text

Editorial (subscription or payment may be required)