GLP-1s Associated With Increased Risk of Neovascular Age-Related Macular Degeneration
Investigators found that longer durations of GLP-1 use were associated with increased risk of nAMD.
Glucagon-like peptide-1 (GLP-1) receptor agonists were associated with an increased risk of neovascular age-related macular degeneration (nAMD) in adult patients with diabetes, according to data published in JAMA Ophthalmology.1 Authors of the study said that more research is needed to understand the exact pathophysiological mechanisms involved.
GLP-1s Associated With Increased Risk of Neovascular Age-Related Macular Degeneration / RFBSIP - stock.adobe.com
Age-related macular degeneration (AMD) is a leading cause of blindness in the United States, especially among White patients. It affects the macula and progresses from early signs like drusen and pigment changes to later vision loss from geographic atrophy or neovascularization. Among adults aged 50 years and older, prevalence ranges from 9.9% to 19.5% for early AMD and 1.1% to 3.9% for late-stage.2
“GLP-1 is an incretin hormone primarily secreted by enteroendocrine L cells in the distal intestine, which plays a pivotal role in glucose homeostasis and promoting satiety,” the authors wrote. “The effects of GLP-1 are mediated through its G-protein–coupled receptor initially identified in the endocrine pancreas and later in various other tissues, including the retina.”
A team of investigators from University of Chicago, University of Washington, and University of Michigan conducted a study to determine if the use of GLP-1s increase the risk of nAMD in patients with diabetes. Data for the study was gathered from comprehensive administrative health and demographic data in Canada by the Institute for Clinical Evaluative Sciences from January 2020 to November 2023.
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The study cohort included 139002 adult patients aged 66 years or older with diabetes. Of the included patients, 46334 were exposed to GLP-1s for longer than 6 months and 92668 were unexposed. Patients were excluded if they did not have at least 12 months of follow up data. Investigators considered multiple comorbidities, including hypertension, dyslipidemia, coronary artery disease, cerebrovascular accident, and chronic kidney disease.
The study found that 0.2% of the patients exposed to GLP-1s had a new diagnosis of nAMD, compared to 0.1% in the group who were not exposed. The higher risk remained consistent even when adjusted for sociodemographic characteristics and comorbidities. Researchers also found outside of GLP-1 use, increased age and history of a cerebrovascular accident increased the risk for nAMD.
Additionally, the investigators found that longer durations of GLP-1 use were associated with increased risk of nAMD.
Study limitations include that the analysis did not stratify by type of GLP-1, that dose, route of administration, or frequency of administration were not accounted for, and that certain variables, such as smoking and sun exposure, were not accounted for.
“These findings suggest clinicians should be aware of the potential ocular complications associated with GLP-1 RA use and are encouraged to report any suspected adverse events to postmarketing pharmacovigilance systems to facilitate safety tracking and raise public awareness,” the authors concluded.
READ MORE: Diabetes Resource Center
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