There has been a substantial increase in demand for semaglutide, a GLP-1 receptor agonist and active ingredient Ozempic, Wegovy and Rybelsus, since the drug received approval from the U.S. Food and Drug Administration (FDA) for weight management in 2021. Epic Research reported a 930% increase, driven by the need to bring down type 2 diabetes and obesity rates, which have also skyrocketed in recent years. The drug is highly effective in glycemic control, leading to weight loss. But despite its effectiveness, a recent study published in JAMA Ophthalmology has uncovered a potential correlation between semaglutide and an increased risk of non-arteritic anterior ischemic optic neuropathy, or NAION, a serious condition that can lead to loss of eyesight.Semaglutide comes with many other side effects as well, mostly related to digestive issues. A study conducted in 2021 and published in Front Endocrinol (Lausanne), reported, “Compared with placebo and active comparator, semaglutide induces mostly mild and transient gastrointestinal disturbances, and increases the risk of cholelithiasis.” It has since been found the drug could lead to other, more serious issues, too, like pancreatitis.Following the FDA’s approval, between January and November 2023, U.S. poison control centers also reported receiving nearly 3,000 calls related to semaglutide,15 times as many semaglutide-related calls as the centers received in 2019. Many of these calls involved individuals with questions about potential side effects and how frequently the drug could be. In some cases, however, the calls are more urgent, with health issues being reported and assistance being required.

Photo by Lisa Fotios from Pexels

NAION is yet another complication as use continues to increase. The second-most common optic neuropathy after glaucoma, the condition has an abrupt onset and is a major cause of blindness. Its causes are largely unknown, although the condition has been linked to certain risk factors including high blood pressure, diabetes, and heart disease.The team use data from the Massachusetts General Brigham centralized data registry to review 16,827 patient records from December 2017 to November 2023, focusing on two main groups – those with T2D and those who were overweight. Both groups were prescribed semaglutide or alternative, non-GLP-1 RA medications to manage their symptoms. The researchers used a 1:2 nearest-neighbor propensity score matching method, accounting for demographic factors, contraindications for semaglutide, and the use of NAION-associated drugs.The study revealed that among the T2D patients, 17 out of 710 semaglutide users developed NAION compared to just six out of 710 non-semantic users. The cumulative incidence of NAION at 36 months was significantly higher in the semaglutide group (8.9%) compared to the non-semantic group (1.8%). In the group with obesity, the frequency of NAION was also higher among semaglutide users, with a cumulative incidence of 6.7% compared to 0.8% in the non-semantic cohort.The increased risk for developing NAION in patients using semaglutide suggests that medical providers should be mindful of this when prescribing the drug, especially for patients who may already be at risk due to underlying health conditions. The vision of patients prescribed the drug should also be closely monitored while under treatment. As the landscape seems to be quickly changing, staying up to date on emerging research is key to ensuring the drug is taken safely.

Sources:

Prescriptions for popular diabetes and weight-loss drugs soared, but access is limited for some patientsSemaglutide associated with increased cases of optic neuropathy, study findsSafety of SemaglutideAs Demand for Semaglutide Rises, So Too Do Poison Control CallsRisk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide