Semaglutide Use Linked to Increased Risk of Nonarteritic Anterior Ischemic Optic Neuropathy

A recent study published in the International Journal of Retina and Vitreous has revealed that the use of once-weekly semaglutide in individuals with type 2 diabetes more than doubles the risk of developing nonarteritic anterior ischemic optic neuropathy (NAION), a serious and irreversible eye condition.

Study Overview

The research, led by Jakob Grauslund, D.M.Sci., Ph.D., M.D., from Odense University Hospital in Denmark, prospectively examined the relationship between semaglutide use and NAION risk. The study analyzed data from 424,152 individuals with type 2 diabetes between 2018 and 2024.

Study Groups:

       • Exposed to Semaglutide: 106,454 individuals.

       • Not Exposed to Semaglutide: 317,698 individuals.

Key Findings

The researchers observed the following:

       • Increased Incidence Rate: Semaglutide users had an incidence rate of 0.228 per 1,000 person-years, compared to 0.093 per 1,000 person-years in non-users.

       • Hazard Ratio: Semaglutide exposure independently predicted a 2.19 times higher risk of developing NAION, even after adjusting for multiple factors.

       • Time to NAION Onset: Among the 67 individuals exposed to semaglutide who developed NAION, the median time from the first prescription to the event was 22.2 months (interquartile range: 10.2 to 37.8 months).

Implications

NAION, a condition that leads to optic nerve damage and vision loss, is irreversible, highlighting the importance of recognizing this potential risk in patients treated with semaglutide.

The study authors emphasized:

“During five years of observation of all persons with type 2 diabetes in Denmark, use of once-weekly semaglutide independently more than doubled the risk of NAION. Given the irreversible nature of NAION, it is important to acknowledge this risk, and upcoming studies should aim to identify high-risk subgroups.”

Future Directions

The findings underscore the need for further research to:

       • Identify High-Risk Subgroups: Pinpoint individuals who may be particularly susceptible to semaglutide-related NAION.

       • Develop Risk Mitigation Strategies: Explore ways to minimize the potential risk while maintaining the therapeutic benefits of semaglutide for type 2 diabetes.

Conclusion

While semaglutide remains a critical treatment for type 2 diabetes, healthcare providers should be aware of its potential association with NAION. Patients should be informed of the risks, and close monitoring may be necessary, particularly for those at higher risk of developing optic neuropathy.

Reference:

Jakob Grauslund et al, Once-weekly semaglutide doubles the five-year risk of nonarteritic anterior ischemic optic neuropathy in a Danish cohort of 424,152 persons with type 2 diabetes, International Journal of Retina and Vitreous (2024). DOI: 10.1186/s40942-024-00620-x