Semaglutide Tied to Nonarteritic Anterior Ischemic Optic Neuropathy

WEDNESDAY, July 3, 2024 — A recent study has revealed that the medication semaglutide, commonly prescribed for type 2 diabetes (T2D) and weight management in patients with overweight or obesity, is associated with a higher incidence of nonarteritic anterior ischemic optic neuropathy (NAION). The findings were published online in JAMA Ophthalmology on July 3.

The research, led by Dr. Jimena Tatiana Hathaway from the Harvard T.H. Chan School of Public Health in Boston, aimed to explore the potential link between semaglutide and NAION. The study utilized a retrospective matched cohort design, analyzing data from 16,827 patients. This cohort included 710 individuals with T2D, of whom 194 were prescribed semaglutide and 516 were given other non-glucagon-like peptide 1 receptor agonist (GLP1-RA) antidiabetic medications. Additionally, 979 patients with overweight or obesity were studied, with 361 receiving semaglutide and 618 prescribed non-GLP1 RA weight-loss drugs.

The study's findings were significant, with researchers observing 17 NAION events among patients taking semaglutide, compared to six events in those prescribed non-GLP1 RA medications. Over a period of 36 months, the cumulative incidence of NAION in T2D patients was 8.9 percent for those on semaglutide, versus 1.8 percent for those on other medications. This translated to a hazard ratio of 4.28, indicating a significantly higher risk for patients on semaglutide. 

For patients with overweight or obesity, the results were similarly concerning. There were 20 NAION events among those prescribed semaglutide, compared to just three in patients on non-GLP1 RA medications. The 36-month cumulative incidence of NAION was 6.7 percent for the semaglutide group, versus 0.8 percent for the non-GLP1 RA group. This corresponded to a hazard ratio of 7.64, suggesting an even greater risk of NAION for this patient population.

Despite these compelling findings, the researchers noted that there has been no prior indication of an increased risk of NAION associated with semaglutide. The study does not provide an explanation for the mechanism by which semaglutide could be linked to NAION, leaving the precise nature of the association unclear.

This study is particularly significant for healthcare providers managing patients with T2D and obesity, as it underscores the importance of monitoring for potential adverse effects associated with semaglutide. Given the increased risk of NAION observed, medical professionals may need to weigh the benefits of semaglutide against this potential risk, especially in patients who may already be at higher risk for optic neuropathies.

In conclusion, while semaglutide is an effective treatment for managing T2D and promoting weight loss, this study highlights a previously unreported association with an increased risk of NAION. Further research is needed to understand the underlying mechanisms and to establish more definitive guidelines for the safe use of semaglutide in these patient populations.

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