{
  "abstract": "Introduction Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA) used to treat type 2 diabetes mellitus (T2D), has potential associations with higher rates of diabetic retinopathy (DR) complications including proliferative DR (PDR) and diabetic macular edema (DME). The purpose of this study was to determine whether an association exists between semaglutide and PDR and treatment-requiring DR/DME.Research design and methods This was a retrospective cohort study of 14 databases (six administrative claims and eight electronic health records) in the Observational Health Data Sciences and Informatics Evidence Network. Adults with T2D on semaglutide, other GLP-1RA (dulaglutide, exenatide), or non-GLP-1RA medications (empagliflozin, sitagliptin, glipizide) from 1 December 2017 to 31 December 2023 were included. The association between semaglutide and PDR or treatment-requiring DR/DME was assessed using an active-comparator cohort design comparing new users of semaglutide as second-line T2D treatment to those on other GLP-1RAs and non-GLP-1RAs. Propensity score-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs). Network-wide HR estimates were generated using a random-effects meta-analysis.Results The study included 810 390 new semaglutide users for T2D. PDR risk for semaglutide was similar to dulaglutide (HR 0.81, 95% CI 0.42 to 1.54, p=0.51), empagliflozin (HR 0.83, 95% CI 0.53 to 1.30, p=0.41) and sitagliptin (HR 0.83, 95% CI 0.45 to 1.55, p=0.57) but was lower than glipizide (HR 0.59, 95% CI 0.39 to 0.88, p=0.01). The risk for treatment-requiring DR/DME for semaglutide was similar to empagliflozin (HR 0.66, 95% CI 0.43 to 1.02, p=0.06) but lower than dulaglutide (HR 0.53, 95% CI 0.31 to 0.91, p=0.02), sitagliptin (HR 0.46, 95% CI 0.26 to 0.81, p=0.008) and glipizide (HR 0.55, 95% CI 0.33 to 0.91, p=0.02).Conclusions and relevance We did not identify increased risk for either PDR or treatment-requiring DR/DME comparing semaglutide with other GLP-1RAs or non-GLP-1RAs. Patients with T2D should still undergo close eye care follow-up, particularly when initiating new antihyperglycemic medications.",
  "authors": [
    {
      "affiliations": [
        "Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA",
        "Biomedical Informatics and Data Science, Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA"
      ],
      "name": "Cindy Xinji Cai"
    },
    {
      "affiliations": [
        "Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"
      ],
      "name": "Akihiko Nishimura"
    },
    {
      "affiliations": [
        "Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA",
        "Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA, USA"
      ],
      "name": "Sally Baxter"
    },
    {
      "affiliations": [
        "National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA"
      ],
      "name": "Kerry Goetz"
    },
    {
      "affiliations": [
        "National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA",
        "Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA",
        "Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA"
      ],
      "name": "Michelle Hribar"
    },
    {
      "affiliations": [
        "Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA"
      ],
      "name": "Brian Toy"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA"
      ],
      "name": "Andrew Barkmeier"
    },
    {
      "affiliations": [
        "Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, California, USA"
      ],
      "name": "Sophia Wang"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA"
      ],
      "name": "Swarup Swaminathan"
    },
    {
      "affiliations": [
        "Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA"
      ],
      "name": "Alexis Flowers"
    },
    {
      "affiliations": [
        "Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA"
      ],
      "name": "Eric Brown"
    },
    {
      "affiliations": [
        "Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA"
      ],
      "name": "Benjamin Xu"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA"
      ],
      "name": "John Chen"
    },
    {
      "affiliations": [
        "Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA",
        "Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA"
      ],
      "name": "Aiyin Chen"
    },
    {
      "affiliations": [
        "Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, California, USA"
      ],
      "name": "Theodore Leng"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, Mass Eye and Ear, Boston, Massachusetts, USA"
      ],
      "name": "Michael Boland"
    },
    {
      "affiliations": [
        "Department of Clinical Practice, Jazan University, Jazan, Jazan, Saudi Arabia",
        "Pharmacy Practice Research Unit, Jazan University, Jazan, Saudi Arabia"
      ],
      "name": "Thamir Alshammari"
    },
    {
      "affiliations": [
        "Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA"
      ],
      "name": "Fan Bu"
    },
    {
      "affiliations": [
        "Department of Biomedical Informatics, Columbia University, New York, New York, USA"
      ],
      "name": "Thomas Falconer"
    },
    {
      "affiliations": [
        "Biomedical Informatics and Data Science, Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA"
      ],
      "name": "Benjamin Martin"
    },
    {
      "affiliations": [
        "Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"
      ],
      "name": "Erik Westlund"
    },
    {
      "affiliations": [
        "Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA"
      ],
      "name": "Nestoras Mathioudakis"
    },
    {
      "affiliations": [
        "Institute for Informatics, Data Science and Biostatistics,Department of Medicine, Washington University in St Louis, St. Louis, Missouri, USA"
      ],
      "name": "Linying Zhang"
    },
    {
      "affiliations": [
        "Institute for Informatics, Data Science and Biostatistics,Department of Medicine, Washington University in St Louis, St. Louis, Missouri, USA"
      ],
      "name": "Ruochong Fan"
    },
    {
      "affiliations": [
        "Institute for Informatics, Data Science and Biostatistics,Department of Medicine, Washington University in St Louis, St. Louis, Missouri, USA"
      ],
      "name": "Adam Wilcox"
    },
    {
      "affiliations": [
        "Institute for Informatics, Data Science and Biostatistics,Department of Medicine, Washington University in St Louis, St. Louis, Missouri, USA"
      ],
      "name": "Albert Lai"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, University of California Davis, Davis, California, USA"
      ],
      "name": "Jacqueline C Stocking"
    },
    {
      "affiliations": [
        "Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA"
      ],
      "name": "Yangyiran Xie"
    },
    {
      "affiliations": [
        "Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA"
      ],
      "name": "Lok Hin Lee"
    },
    {
      "affiliations": [
        "Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA"
      ],
      "name": "David Dorr"
    },
    {
      "affiliations": [
        "Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR, USA"
      ],
      "name": "Izabelle Humes"
    },
    {
      "affiliations": [
        "Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR, USA"
      ],
      "name": "David McCoy"
    },
    {
      "affiliations": [
        "Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR, USA"
      ],
      "name": "Mohammad Adibuzzaman"
    },
    {
      "affiliations": [
        "Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA"
      ],
      "name": "Raymond Areaux, Jr"
    },
    {
      "affiliations": [
        "IQVIA, Real World Solutions, Brighton, England, UK"
      ],
      "name": "James Brash"
    },
    {
      "affiliations": [
        "Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA"
      ],
      "name": "Nicole Weiskopf"
    },
    {
      "affiliations": [
        "Stanford School of Medicine and Stanford Health Care, Stanford, California, USA"
      ],
      "name": "Hannah Morgan-Cooper"
    },
    {
      "affiliations": [
        "Stanford School of Medicine and Stanford Health Care, Stanford, California, USA"
      ],
      "name": "Priya Desai"
    },
    {
      "affiliations": [
        "Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA"
      ],
      "name": "Diep Tran"
    },
    {
      "affiliations": [
        "Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA"
      ],
      "name": "Zainab Rustam"
    },
    {
      "affiliations": [
        "Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA"
      ],
      "name": "Gina Zhu"
    },
    {
      "affiliations": [
        "Janssen Research & Development, Titusville, New Jersey, USA"
      ],
      "name": "Joel Swerdel"
    },
    {
      "affiliations": [
        "Janssen Research & Development, Titusville, New Jersey, USA",
        "Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands"
      ],
      "name": "Anthony Sena"
    },
    {
      "affiliations": [
        "Biomedical Informatics and Data Science, Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA"
      ],
      "name": "Paul Nagy"
    },
    {
      "affiliations": [
        "Department of Biostatistics, University of California Los Angeles School of Public Health, Los Angeles, California, USA",
        "VA Informatics and Computing Infrastructure, US Department of Veterans Affairs, Salt Lake City, UT, USA"
      ],
      "name": "Marc Suchard"
    },
    {
      "affiliations": [
        "Department of Biostatistics, University of California Los Angeles School of Public Health, Los Angeles, California, USA",
        "Johnson and Johnson, Horsham, PA, USA"
      ],
      "name": "Martijn Schuemie"
    },
    {
      "affiliations": [
        "Department of Biomedical Informatics, Columbia University, New York, New York, USA"
      ],
      "name": "George Hripcsak"
    },
    {
      "affiliations": [
        "Department of Biomedical Informatics, Columbia University, New York, New York, USA",
        "Johnson and Johnson, Horsham, PA, USA"
      ],
      "name": "Patrick Ryan"
    }
  ],
  "title": "Semaglutide and diabetic retinopathy: an OHDSI network study",
  "uid": "0024965f-9e92-5164-b1a8-71e0b2403ee6"
}