Optic Ischaemic Neuropathy in Incretin-Based Therapy: A Comparative Analysis of Real-World Safety Data.
Semaglutide reports show far higher reporting odds of optic ischaemic neuropathy than other drugs.
Optic Ischaemic Neuropathy in Incretin-Based Therapy: A Comparative Analysis of Real-World Safety Data.
Non-arteritic anterior ischemic optic neuropathy (NAION) has emerged as a safety concern with semaglutide, prompting formal regulatory review and action by the European Medicines Agency.
Adverse event reports from each drug's approval date through Q3 2025 were extracted using OpenVigil 2.1.
eye nerve damage reports are far more common than with other diabetes drugs
Tirzepatide and liraglutide also exhibited significant safety signals (49 reports; reporting odds ratio 2.94, 95% CI: 2.20-3.93; proportional reporting ratio 2.94, 95% CI: 2.20-3.93; and 13 reports; reporting odds ratio 4.58, 95% CI: 2.65-7.91; proportional reporting ratio 4.58, 95% CI: 2.65-7.91, respectively).
No signal was identified for dulaglutide, exenatide, or lixisenatide.
Among semaglutide-associated reports, mean age was 59 years; disability was documented in 18% and hospitalization in 11% of cases.
Significant post-marketing safety signals for optic ischaemic neuropathy were identified for semaglutide, tirzepatide, and liraglutide.
The absence of signals with other glucagon-like peptide-1 receptor agonists argues against a uniform class effect.
Prospective studies with neuro-ophthalmologist-confirmed diagnoses are warranted to establish causality and quantify absolute risk.