Albiglutide Increases Risk for Early-Stage Diabetic Retinopathy

Albiglutide use is associated with a significantly higher risk of early-stage diabetic retinopathy (DR), according to research presented at the American Society of Retina Specialists 41st Annual Scientific Meeting, held in Seattle, July 28 to August 1, 2023. 

Lead study author Ishani Kapoor, and colleagues searched ClinicalTrials.gov for randomized clinical trials comparing FDA-approved glucagon-like peptide-1 receptor agonists (GLP-1 RAs) (semaglutide, albiglutide, dulaglutide, liraglutide, lixisenatide, exenatide, and tirzepatide) with placebo, insulin, or oral anti-diabetic medicine (OAD). The research team only included trials done on patients with a type 2 diabetes mellitus (T2DM) diagnosis and reporting any ocular adverse event (AE).

The researchers found that GLP-1 RA use was significantly associated with early-stage DR (RR=1.31, 95% CI [1.01, 1.68]) and early-stage retinal AEs (RR=1.29, 95% CI [1.01, 1.66]) compared with placebo. They found that GLP-1 RA use protected against late-stage DR (RR=0.38, 95% CI [0.15, 0.98]) compared with insulin. 

Analysis of individual GLP-1 RAs shows that albiglutide is significantly associated with a higher risk of early-stage DR (RR=2.18, 95% CI [1.01, 4.67]) compared with placebo, and a lower risk of late-stage DR (RR=0.25, 95% CI [0.09, 0.70]) compared with insulin. 

Albiglutide had comparable effects on retinal and ocular AEs, the report shows.  

Semaglutide is significantly associated with a higher risk of early-stage ocular AEs compared with placebo (RR=1.26, 95% CI [1.03, 1.53]), while dulaglutide is significantly associated with a lower risk of late-stage ocular AEs compared with placebo (RR=0.62, 95% CI [0.42, 0.92]).

“The strength of these effects depends on the specific GLP-1 RA used, patient specific clinical characteristics, and demographics,” according to the researchers. “Albiglutide is the only GLP-1 RA with an increased risk of early-stage DR compared to placebo.”

Study limitations include that DR was reported as an AE rather than a primary outcome of the clinical trials, and some trials included patients with DR at baseline, which made it difficult to differentiate the association between GLP-1 RAs and DR as one of development or temporary worsening.