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Despite recommendations to consult with ophthalmologists prior to initiating semaglutide, the cardiometabolic drug was not found to be linked to worsened DR outcomes.
According to new data presented at the 127th Annual American Academy of Ophthalmology (AAO) Congress in San Francisco, California this week, the incidence of vision-threatening complications in patients with DR who are initiating semaglutide for T2D is relatively low for the following 3 – 24 months. The findings buck against recommendations calling for patients to consult with ophthalmologists prior to initiating semaglutide.
A US-based team of investigators, led by Zeeshan Haq, MD, of the Retina Consultants of Minnesota, sought to evaluate changes in DR disease status or severity in patients who recently initiated semaglutide. They believed the findings could impact current screening guidelines, monitoring schedules, and patient counseling strategies among ophthalmologists and other specialists managing semaglutide prescriptions.
“Semaglutide is an antihyperglycemic medication with multiple benefits,” Haq and colleagues wrote. “Its use has been associated with an increased risk of DR complications. Semaglutide is also approved for weight loss in patients with obesity or who are overweight with a weight-related condition.”
The team conducted a retrospective noncomparative case series analysis of data from the Intelligent Research in Sight Registry. Eligible patients had diagnosed T2D mellitus and were initiated on non-oral semaglutide between 2013 – 2021; minimum follow-up data duration was 3 months.
The team’s total eligible cohort included 96,432 patient eyes; three-fourths (77.2%) were aged 51 – 75 years old. A majority of patients were female (55.0%), White (63.8%), and lived in either the South or Midwest (59.4%).
Approximately one-fourth of patients had either mild or moderate non-proliferative DR (NPDR; 18.4%), or severe NPDR or proliferative DR (PDR; 9.8%) at baseline. The remaining 71.8% of participants had no baseline DR.
The rate of eyes that which worsened in DR status after initiating semaglutide increased from 1.3% at 3 months, to 2.2% at 24 months. Among eyes with mild to moderate NPDR, the rates were 2.4% and 3.5% for those time periods, respectively.
Conversely, the rate of eyes with severe NPDR or PDR that which improved in disease status after initiating semaglutide increased from 40.0% at 3 months, to 58.7% at 24 months.
Fewer than 1% of patient eyes with NPDR initiating semaglutide were diagnosed with PDR at 3, 6, 12 and 24 months each. The same was observed for rates of NPDR eyes developing diabetic macular edema after initiating semaglutide.
Among observed complications, more patient eyes with DR were likely to report vitreous hemorrhages at both 3 months (0.15%) and 24 months (0.10%) than they were tractional retinal detachment (0.05% and 0.02%) or neovascular glaucoma (0.04% and 0.04%) at those time points, respectively.
Haq and colleagues concluded that a majority of the eyes with DR reported no worsening of disease status after patients initiating semaglutide to treat T2D.
“Incidence of vision-threatening complications related to DR was relatively low at multiple time points after initiation of semaglutide,” they wrote.
Haq Z, Lum F, Parke DW. Changes in Diabetic Retinopathy After Initiation of Semaglutide. Abstract presented at: American Academy of Ophthalmology Congress. San Francisco, CA. November 3 – 6, 2023.