A study recently published in Ophthalmology Glaucoma investigated the connection between adverse drug effects and primary angle-closure glaucoma (PACG).
Give me some background first.
PACG has been associated with a number of risk factors along with possible traits of predisposition, demonstrating the importance of understanding preventable causes.
Even further, medications for various uses—including anticholinergics, cholinergics, sulfonamides, supplements, and serotonergic medications—have been linked to PACG induction.
Thus, researchers here aimed to both identify and quantify drug-induced angle-closure glaucoma (ACG) across the United States population.
Now, talk about the study.
Data was pulled from the FDA Adverse Event Reporting System (FAERS) database from the FDA, which collects adverse events (AEs) and medication errors reported by the pharmaceutical industry, healthcare providers and consumers.
The investigators focused on reports from 2004 through Q3 2023. Out of 11,737,133 AE reports, 1,629 were related to PACG, and 611 drugs were suspected.
Go on…
The study narrowed down a total of 50 top drugs that each had at least 15 AE reports correlating with PACG. Drugs utilized in the treatment of PACG were omitted.
Findings?
The most frequently reported drug category was sulfonamides, with most of those results coming from topiramate. The overall top reported drugs included:
- Topiramate (520 reports)
- Citalopram (69 reports)
- Levothyroxine (68 reports)
- Escitalopram (58 reports)
- Duloxetine (45 reports)
- Salbutamol (44 reports)
Tell me more.
The cohort consisted of 66.1% women. The FAERS analysis saw a predominance in women, which the authors noted was consistent with past literature identifying female sex as a risk factor.
Expert opinion?
Per the researchers: “Sympathomimetic agents, anticholinergic agents, and serotoninergic agents can induce pupillary dilation and block leading to acute angle closure by inducing constriction of the iris dilator muscles.”
They continued: “This may induce acute angle closure in patients by thickening the base of the iris, resulting in iridotrabecular adhesions, or by bringing the lens in close proximity to the iris in mid-dilation.”
Limitations?
The authors noted that bias and underreporting were possibly introduced due to the self-reported nature of the database incidents. Comorbidities and use of multiple drugs were also possible confounding influences not explored.
While the researchers performed disproportionality analysis, they maintained that clinical trials will be imperative to confirm findings.
Take home.
Ultimately the investigators discovered “positive safety signals for both well-known drugs such as topiramate, escitalopram, and tiotropium, as well as lesser-known drugs such as olanzapine, phentermine, and ranibizumab.”
They concluded that while further trials and research are needed, these findings are important for clinician awareness and patient safety.