Semaglutide May Reduce Rates of Diabetic Retinopathy Outcomes

Sanya Yadav MD

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Semaglutide was linked to a significantly lower likelihood of diabetic retinopathy outcomes, including diabetic macular edema (DME) and the need for intravitreal anti-vascular endothelial growth factor (VEGF) injections, according to data presented at the American Society of Retina Specialists (ASRS) 42nd Annual Meeting.¹

“This analysis suggests that the use of semaglutide may be beneficial in reducing rates of DME and vitreous hemorrhage in patients with diabetic retinopathy, as well as rates of intravitreal injection, pars plana vitrectomy (PPV), and pan-retinal photocoagulation (PRP) in retinopathy patients,” wrote the investigative team, led by Sanya Yadav MD, department of ophthalmology, West Virginia University.

Evidence has not defined a clear association between semaglutide use and diabetic retinopathy outcomes—some studies demonstrate worsening, while other long-term data have reported no notable overall association.²

For this analysis, Yadav and colleagues evaluated the large, multi-center TriNetX database to investigate a possible association between semaglutide and diabetic retinopathy outcomes in a diverse patient population with a long follow-up period.¹

All patients diagnosed with all severities of retinopathy were identified using relevant ICD-10 codes and divided into two cohorts: those prescribed semaglutide after retinopathy diagnosis and those not on semaglutide. Those with co-morbid retinal diseases, including prior rhegmatogenous retinal detachment, retinal degeneration, and chorioretinal inflammation, were excluded from both cohorts.

Cohorts were matched based on age, sex, and systemic comorbidities. Analysis outcomes included the incidence of DME, the need for intravitreal anti-VEGF injections, vitreous hemorrhage, PPV, and PRP. Each outcome was evaluated using odds ratio (OR) at intervals of 1 year, 5 years, and the lifetime between the two cohorts.

Overall, 57,680 patients were included in the study, including 28,840 patients in each cohort. Upon analysis, patients treated with semaglutide had significantly lower odds of all outcomes in the analysis.

Patients treated with semaglutide had significantly lower odds of DME at 1 year (OR, 0.52 [95% CI, 0.47 – 0.58), 5 years (OR, 0.45 [95% CI, 0.42 - 0.49]), and lifetime (OR, 0.42 [95% CI, 0.39 – 0.45]). Those treated with semaglutide also exhibited a reduced need for intravitreal anti-VEGF injections at 1 year (OR, 0.63 [95% CI, 0.56 – 0.71]), 5 years (OR, 0.55 [95% CI, 0.50 – 0.61]), and lifetime (OR, 0.48 [95% CI, 0.44 – 0.53]).

Rates of vitreous hemorrhage were lower in semaglutide-treated patients at 1 year (OR, 0.37 [95% CI, 0.32 - 0.42]), 5 years (OR, 0.36 [95% CI, 0.32 - 0.41]), and lifetime (OR, 0.31 [95% CI, 0.28 - 0.35]). The need for PPV was also reduced in those treated with semaglutide at 1 year (OR, 0.43 [95% CI, 0.33 – 0.55]), 5 years (OR, 0.41 [95% CI< 0.34 - 0.49]), and lifetime (OR, 0.39 [95% CI, 0.33 – 0.47]).

PRP procedure rates were also lessened in semaglutide-treated patients at 1 year (OR, 0.33 [95% CI, 0.28–0.39]), 5 years (OR, 0.32 [95% CI, 0.28–0.36]), and lifetime (OR, 0.28 [95% CI, 0.25–0.32]).

In their conclusion, Yadav and colleagues indicated these data provide more evidence to support the safety of semaglutide in patients with retinopathy for glycemic control, but noted the limitations of these findings.

“Limitations include the retrospective and observational design,” they added. “Rates of disease and outcomes are also dependent on accurate ICD-10 and CPT coding.”

References

1. _{Yadav S. Association Between Semaglutide Use and Diabetic Retinopathy Outcomes Using a Large Multicenter Database. Poster presented at the American Society of Retina Specialists (ASRS) 42nd Annual Meeting. Stockholm, Sweden. July 17-20, 2024.}
2. _{Cigrovski Berkovic M, Strollo F. Semaglutide-eye-catching results. World J Diabetes. 2023;14(4):424-434. doi:10.4239/wjd.v14.i4.424}