Risk of Retinal Vein Occlusion between Glucagon-Like Peptide-1 Receptor Agonists and Dipeptidyl Peptidase-4 Inhibitors in Type 2 Diabetes: A Retrospective Cohort Study.

Objective: To evaluate whether glucagon-like peptide-1 receptor agonists (GLP-1RAs) are associated with reduced retinal vein occlusion (RVO) risk compared with dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with type 2 diabetes mellitus (T2DM). Design: A multinational, retrospective cohort study. Participants: Adults with T2DM newly prescribed GLP-1RAs or DPP-4 inhibitors between 2006 and 2023 were included in our analysis. Methods: This study leveraged data from populations across 21 countries. Propensity score matching at a 1:1 ratio balanced age, sex, race, glycated hemoglobin (HbA1c), body mass index (BMI), estimated glomerular filtration rate, medications, and comorbidities between GLP-1RA and DPP4 inhibitor users. Main Outcomes Measures: We observed the occurrence of incident RVO and branch RVO (BRVO) in the overall population and in subpopulations stratified by age, sex, race, GLP-1RA type, baseline HbA1c, BMI, and diabetes duration. Results: Among 79 486 matched participants, GLP-1RA use is associated with a lower risk of RVO (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.54-0.98) and BRVO (HR, 0.62; 95% CI, 0.41-0.95) over 5 years compared with DPP-4 inhibitor use. This association is consistent among patients aged ≥50 years, Blacks, those prescribed human-analog GLP-1RAs, and those with baseline HbA1c ≥8%, BMI ≥30 kg/m Conclusions: Glucagon-like peptide-1 receptor agonist use was linked to reduced RVO and BRVO risks in patients with T2DM when compared with DPP-4 inhibitor use, particularly in high-risk populations, suggesting potential benefits of GLP-1RAs over DPP-4 inhibitors in managing ocular complications in T2DM. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.