Semaglutide Not Associated with Worsening of Diabetic Retinopathy Progression

Blake Cooper, MD, MPH

Semaglutide use was not associated with an increased risk of progression of diabetic retinopathy (DR), visual loss, or an increased number of intravitreal injections over a 12-month period, according to new findings.

“If confirmed by prospective clinical trials, these findings would offer reassurance that the long-term use of Semaglutide does not lead to progression of DR and sight-threatening disease,” wrote study author Blake Cooper, MD, MPH, Retina Associates.

The findings were presented at the Association for Research in Vision and Ophthalmology (ARVO) 2022 Meeting in Denver, Colorado.

In a preapproval cardiovascular outcomes study, rapid glycemic control and hemoglobin A1c have been associated with worsening of DR with semaglutide use. With other medications, the paradoxical worsening of DR after a sudden drop in blood glucose is well-documented. Meanwhile, for semaglutide, the long-term effects of acute worsening of DR remained unclear.

Investigators in the current study hypothesized if worsening of DR occurs with semaglutide in patients with type 2 diabetes (T2D), it will be temporary and have no associated with continued DR progression.

The retrospective data analysis identified 4086 patients with T2D and DR by International Classification of Diseases 10th revision (ICD-10) codes in a Retina only practice from January to June 2020.

Investigators found semaglutide use in 116 patients. Inclusion criteria for the study included ≥1 year of semaglutide and documentation of the level of non-proliferative (NPDR) and proliferative retinopathy (PDR), visual acuity (VA), and central subfield thickness (CST).

A total of 87 patients met inclusion criteria and were included for descriptive analysis. This population included 36 female patients (41.4%) with an average age of 62.4 years.

At baseline, the baseline level of DR range was 11.5% with mild NPDR (level 10), 38.5% moderate NPDR (level 35 - 43), 14.4% severe NPDR (level 47 - 53), and 35.6% PDR (level 61 - 85).

Investigators found the level of retinopathy progressed over one year in 5.7% of eyes, saw improvement in 8% of eyes, and remained stable in 86.2% of eyes. Throughout a one-year period, visual acuity remained unchanged in 72.4% of patients while 12.6% of patients lost >2 lines of vision in ≥1 eye and 14.9% gained >2 lines of vision in ≥1 eye.

Further, the CST remained unchanged in 44.2% of patients, increased by ≥10% in one eye of 25.6% of patients, and decreased by ≥10% in one eye of 30.2% of patients. Investigators observed intravitreal injections were required in ≥1 eye of 63.2% of patients with an average number of injections of 6.1 per patient.

“Our study showed no worsening of retinopathy for those taking semaglutide over one year,” Cooper concluded.

The study, “Risk of Diabetic Retinopathy (DR) Progression in Patients during 1 year of Semaglutide use,” was presented at ARVO 2022.