A Pharmacovigilance Analysis of Ocular Adverse Events Associated with GLP-1 Receptor Agonists.
This pharmacovigilance study analyzed ocular adverse event (AE) reports associated with five GLP-1 receptor agonists (exenatide, tirzepatide, dulaglutide, liraglutide, and semaglutide) using the FDA Adverse Event Reporting System (FAERS) from 2005 to 2024. Ocular AEs comprised 3.61% of all GLP-1 RA-related reports; the median patient age was 63 years, and 62.6% of reports involved female patients. Disproportionality analysis using reporting odds ratios (RORs) identified a statistically significant signal for ocular AEs associated with semaglutide, while exenatide showed a significant annual decline in proportional reporting (-5.15% per year). The authors note that semaglutide's signal may partly reflect its growing market dominance rather than a true differential risk. Key limitations acknowledged by the study include the absence of exposure denominators and comparator groups, vulnerability of FAERS to reporting bias (including under- and over-reporting), and inability to establish causality. The authors characterize the findings as hypothesis-generating and recommend clinician vigilance regarding ocular monitoring, particularly in populations already at elevated risk for diabetic eye disease, while calling for further prospective research to validate these associations and explore potential mechanisms.
Why this grade: Passive pharmacovigilance database analysis using FAERS lacks exposure denominators, comparator arms, and causal inference capacity, limiting conclusions to signal detection only.
Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for type 2 diabetes in addition to other conditions such as obesity. As their use expands, understanding potential ocular safety signals is important, particularly in populations already at risk for diabetic eye disease. The aim of this study is to identify potential pharmacovigilance safety signals for ocular adverse events (AEs) related to GLP-1 RA medications to better inform future clinical practice. Methods: This study utilized the publicly available FDA Adverse Event Reporting System (FAERS) to obtain AE reports related to exenatide, tirzepatide, dulaglutide, liraglutide, and semaglutide from 2005 to 2024. Reports were categorized by demographic and geographic variables. Disproportionality analysis using reporting odds ratios (RORs) was performed to detect potential safety signals. Year-over-year trends in the proportional representation of each drug were also assessed through linear regression and time series plots. Results: Ocular AEs represented 3.61% of all GLP-1 RA related reports. Median age was 63 years, and 62.6% of reports involved female patients. Exenatide accounted for 33.61% of ocular AEs but showed a significant annual decline in reporting (-5.15% per year, p p Conclusions: This pharmacovigilance analysis identifies potential ocular AE signals associated with GLP-1 RAs, particularly semaglutide. While semaglutide showed a statistically significant disproportional reporting signal for ocular AEs, the absence of exposure denominators, comparator groups, and the susceptibility of FAERS to reporting bias means these findings are hypothesis-generating rather than causal. Clinicians should remain vigilant and consider eye care referrals when indicated. Further research is needed to validate these associations and clarify underlying mechanisms.
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