Potential rare vision complications tied to blockbuster GLP-1s

[Protein Data Bank]

A new case series published in JAMA Ophthalmology has spotlighted rare but potentially serious vision issues in patients taking semaglutide or tirzepatide, two popular glucagon-like peptide-1 (GLP-1) receptor agonists commonly used to treat diabetes and aid weight loss.

In the investigation, nine individuals reported sudden vision changes while on semaglutide or tirzepatide; seven of these cases involved nonarteritic anterior ischemic optic neuropathy (NAION), often described as an “eye stroke.” One patient developed papillitis, and another experienced paracentral acute middle maculopathy. Although this small study does not establish a direct cause-and-effect link, it underscores the importance of ongoing monitoring for vision issues in patients on these therapies.

Separately, Axios reports a sort of backlash against the therapeutic class. “There is almost like a backlash kind of a sentiment going on,” Peter Antall, chief medical officer of digital chronic health company Lark, told the publication.

Ozempic hit the U.S. scene in 2018 and quickly became a blockbuster. It grew from about $0.3 billion in global sales in 2018 to $1.65 billion in 2019 thanks to its popularity among type 2 diabetes patients. In 2021, as use broadened (including off-label weight-loss use), U.S. spending on semaglutide drugs (Ozempic and the oral version Rybelsus) hit $10.7 billion, a 90% increase over 2020, making semaglutide the fourth highest-spend drug class in the U.S.

In the following years, Novo Nordisk’s U.S. sales for Ozempic continued to accelerate, jumping from approximately 65% in 2022 to over $5.5–6.0 billion (out of $8.5B global Ozempic sales that year). By 2023, Ozempic had grown into one of the world’s top-selling drugs at $13.9 billion globally, as we reported. The U.S. contributed a majority of that total. This explosive growth made Ozempic Novo Nordisk’s best-selling product, accounting for about 40% of the company’s revenue in 2023.

Wegovy (semaglutide 2.4 mg for obesity) hit the market in mid-2021 and saw meteoric growth despite supply constraints. Its sales were $876 million in 2022 largely stemming from U.S. prescriptions. In just the first half of 2023, Wegovy sales surpassed $1 billion, and by Q3 2023 it had reached $3.1 billion in revenue (first nine months of 2023). This reflects more than 490% year-over-year growth as manufacturing capacity expanded to meet pent-up U.S. demand.