News release

From: American College of Physicians

U.S. study suggests GLP-1 RA drugs are associated with small increase in ischemic optic neuropathy

A target trial emulation found that people with type 2 diabetes who start glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy had a slightly higher risk for ischemic optic neuropathy (ION), a rare condition involving reduced blood flow to the optic nerve that can cause sudden vision loss, compared with those initiating sodium–glucose cotransporter-2 inhibitors (SGLT2is) or dipeptidyl peptidase-4 inhibitors (DPP4is); however, absolute risk was very low. The findings add to limited evidence of a possible association between GLP-1RAs and ION, but they should be interpreted cautiously due to the potential for residual confounding. The study is published in Annals of Internal Medicine.

Researchers from Rutgers University analyzed U.S. insurance claims data of adults aged 18 to 65 years with type 2 diabetes from 2017 to 2022 to compare the risk for ION, a condition that causes sudden vision loss, among initiators of GLP-1 RAs versus SGLT-2is or DPP-4is. Over 18 months, ION occurred in fewer than 1 in 1,000 patients across all groups, though rates were modestly higher among those taking GLP-1RAs. The authors conclude that while an association was observed, the absolute risk was low, and the findings may partly reflect differences in patients’ underlying health rather than a direct effect of the medications.

Large Swedish study suggests low overall risk of sudden vision loss with GLP-1 RA use

A nationwide cohort study found a slightly higher risk for nonarteritic anterior ischemic optic neuropathy (NAION) among users of glucagon-like peptide-1 receptor agonists (GLP-1RAs) compared with sodium–glucose cotransporter-2 (SGLT-2) inhibitor use. However, absolute risks were small, and differences in risk may be partly due to differences in patients’ underlying health. The study is published in Annals of Internal Medicine.

Researchers from the Karolinska Institutet used nationwide health data of patients aged 35 to 84 years with type 2 diabetes in Sweden between 2013 and 2024 to emulate a pragmatic target trial assessing the effect of GLP-1RA use on risk for NAION, a condition that causes sudden vision loss in one eye. Of 107,518 GLP-1RA initiators and 185,898 SGLT-2 inhibitor initiators, the risk for anterior ischemic optic neuropathy was 0.04% and 0.02% after one year, respectively. While the relative risk was higher in the GLP-1 group, differences were smaller in analyses that accounted more closely for diabetes severity. The authors conclude that there may be an association influenced by other patient factors.