SGLT2 Inhibitors Increase Risk of Retinal Vein Occlusion

Researchers found a significant interaction between SGLT2 inhibitors based on age and eGFR.

In data presented as a late-breaking poster at the 2021 American Diabetes Association Virtual Meeting, a team, led by Min-Kyung Lee, Goyang-si, Gyeonggi-do, assessed the link between the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors and retinal vein occlusion (RVO).

In the study, the researchers used data from the National Health Insurance Service in South Korea between 2014-2017, an active comparator, and a new user design.

Methods

The team used a 1:1 propensity score match to identify 47,369 new users of SGLT2 inhibitors and 47,369 users of the other glucose-lowering drugs (oGLD).

The mean follow-up time for the primary intention-to-treat analysis was 2.57 years and the researchers used Cox proportional hazards regression modeling to estimate hazard rations with 95% confidence intervals for RVO.

In addition, based on the main outcome, a prespecified subgroup analysis was conducted.

During the follow-up period there was an incidence rate of RVO of 2.19 and 1.79 per 1000 person-years in the SGLT2 inhibitor group and the other glucose-lowering drug arm.

SGLT2 Inhibitors

SGLT2 inhibitor use was associated with an increased risk of RVO compared with oGLD use (HR, 1.264; 95% CI, 1.056-1.513).

After analyzing the subgroup, the researchers found a significant interaction with SGLT2 inhibitors observed for age and estimated glomerular filtration rate (eGFR).

The hazard ratio for RVO was higher in patients at least 60 years old, as well as in those with eGFR <60 mL/min/1.73m2 than in others.

“In a matched cohort study, we found that SGLT2 inhibitors were associated with a significantly increased risk of RVO,” the authors wrote. “The elderly and patients with chronic kidney disease were at higher risk for RVO.”

Retinal Vein Occlusion

Earlier this year, researchers found fluticasone acetate implants were considered safe and effective in patients with macular edema due to retinal vein occlusion.

In the study, all eyes received an injection with a fluticasone implant, and the investigators proceeded to evaluate central retinal thickness outcomes.

They also took note of any complications, including cataract progression and increased intraocular pressure (IOP).

As such, they noted that visual acuity improved following injection, as documented in the patients’ final follow-up visit. At baseline, mean visual acuity was 0.39 versus 0.26 at final visit (P = .02).

They also observed that mean central retinal thickness improved from 412 mm at baseline to 302 mm at 6 months (P = .01). However, thickness increased to 345 mm by final follow-up (P = .3).

Further, phakic patients demonstrated cataract progression, thus leading them to require phacoemulsification surgery.

And finally, 7 patients required IOP lowering medications, and 2 patients required glaucoma filtration surgery.

The study, “Sodium–Glucose Cotransporter-2 Inhibitors and Risk of Retinal Vein Occlusion among Patients with Type 2 Diabetes: A Propensity Score–Matched Cohort Study,” was published online by ADA.