Publication

Article

Digital Edition
Ophthalmology Times: October 1, 2020
Volume 45
Issue 16

Antihyperglycemic drug linked to reduced risk of new onset AMD

Research could lead to a novel therapeutic strategy for blinding disease


This article was reviewed by Andrea Blitzer, MD

Reduction in the risk of developing age-related macular degeneration (AMD) may be another benefit of metformin for protecting against age-related diseases, according to a case-control study undertaken by a team of investigators at the University of Chicago.

Led by Dimitra Skondra, MD, PhD, an associate professor in the Department of Ophthalmology and Visual Science, the research analyzed 10 years of data from the IBM MarketScan Commercial and Medicare Supplemental databases.

Related: Targeting AMD patient treatment burden

It found that the strongest effect occurred at low to moderate doses of metformin, was not restricted to patients with diabetes, but was not present among patients with diabetes who had diabetic retinopathy.

Andrea Blitzer, MD, a member of Skondra’s team and an ophthalmology resident at the University of Chicago, presented the findings at the Association for Research in Vision and Ophthalmology 2020 virtual annual meeting.

“Further studies are needed to confirm the protective benefit that we identified for metformin and to investigate the underlying pathways,” she said. “If our findings are confirmed in clinical trials, the research may lead to a novel therapeutic strategy for this blinding disease.”

Related: Easing patient comfort, pain perception of intravitreal injections​


Impetus for research

Previous studies found that metformin reduced the incidence of diabetes mellitus, diabetes-related mortality, cardiovascular diseases, cancer, dementia, and all-cause mortality. It has also been reported to reduce the risk of glaucoma.

“Metformin targets mediators and pathways that affect inflammation, cell survival, stress defense, oxidative stress,” Blitzer said. “All of these can play a role in health span and longevity, and a number of the pathways and mediators that are targets for metformin have also been implicated in the pathogenesis of AMD.”

Blitzer noted that these details led to Skondra’s study investigating whether metformin decreases the risk of developing AMD using a big data approach.

Related: Contrast sensitivity shows potential for measuring visual function loss in early AMD

Study details
The cases and controls for the research were identified through a search of the MarketScan database for the years 2008 to 2017. The study looked at people 55 years of age or older who had newly diagnosed AMD.

A control subject was selected for each case from among a pool of 31 million patients and matched by age, comorbidities, and region of the United States. The investigators were able to determine metformin usage based on claims data.

The study looked at a total of 312,404 cases that were then matched with controls. Compared with the controls, patients with AMD were more likely to smoke, to have hyperlipidemia, and to have diabetic retinopathy.

In a multivariate model adjusting for risk factors and other medications, the use of metformin significantly decreased the risk of being newly diagnosed with AMD within 2 years by 6%.

Related: Deep learning algorithm proving accurate for AMD classification

With stratification by metformin dose, patients who had received low to moderate doses had the greatest risk reduction (9% and 10%, respectively).

Because metformin is primarily used as an antihyperglycemic drug, the investigators also analyzed the data to see if the potential protective effect of metformin on AMD development occurred only in the cohort of patients with diabetes. They found that the protective effect was similar in the diabetic cohort as in the overall cohort.

With cases more likely than controls to have diabetic retinopathy, another analysis considered if the presence of this ocular complication of diabetes was an important factor for metformin’s risk reduction. The benefit of metformin only occurred in the absence of diabetic retinopathy, the team reported.

Finally, a protective benefit of other antihyperglycemic medications and statins was investigated.

Related: Vision-related quality of life: Impacts of advanced AMD

In multivariate models, other diabetic medications seemed to have a mild protective effect as well, but metformin remained protective even in multivariate analysis adjusting for the effects of other medications

“Metformin is a well tolerated and is the most commonly used oral medication to treat diabetes,” Skondra concluded. “The findings from our team may uncover a role for its use as a possible therapeutic intervention for AMD as well.”

Read more by Cheryl Guttman Krader


--

Dimitra Skondra MD, PhD
e:dskondra@bsd.uchicago.edux
Skondra has no relevant financial interests to report.

Andrea Blitzer, MD
e:andrea.blitzer@uchospitals.edu
Blitzer has no relevant financial interests to report.

Related Videos
EyeCon 2024: Adam Wenick, MD, talks about myopic interventions across the lifespan
Adam Wenick, MD, chairs EyeCon session: New treatments in geographic atrophy from detection to intervention
EyeCon 2024: Key takeaways for enhanced patient care from Day 1
EyeCon 2024: Peter McDonnell, MD, and Laura Periman, MD, on the importance of integrating new knowledge into practice
Arun Gulani, MD: How the Gni instrument enhances precision and control in cataract surgery
EyeCon 2024: Laura M. Periman, MD, shares her passion for dry eye disease, discussing her surprising discovery of the Alpenglow Sign in Demodex blepharitis
David Eichenbaum, MD, presents advances in AMD therapy, highlights different mechanisms with a common goal
1 KOL featured in this series.
1 KOL featured in this series.
1 KOL featured in this series.
© 2024 MJH Life Sciences

All rights reserved.