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Joshua D Stein, Nidhi Talwar, Jae H Kang, Janey L Wiggs, Louis R Pasquale; The Impact of Bupropion Use on the Risk of Open-Angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1666.
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Tumor Necrosis Factor (TNF) mediates retinal ganglion cell death in glaucoma. Anti-TNF drugs are neuroprotective in an animal model of glaucoma. Bupropion is a commonly prescribed agent with an acceptable side effect profile that has anti-TNF properties. The purpose of this study is to determine whether bupropion use is associated with the risk of developing open-angle glaucoma (OAG).
Claims data from a cohort of patients age ≥35 years who were continuously enrolled in a nationwide U.S. managed care plan for ≥4 years in which beneficiaries had at ≥2 visits to an eye-care provider between 2001-2011 were reviewed. The amount of bupropion use for each enrollee was captured from outpatient pharmacy claims over a four-year period. Multivariable Cox regression analyses were performed to determine whether bupropion use affected the hazard of developing incident OAG. Regression models were adjusted for sociodemographic factors, medical and ocular comorbidities.
Of 638,481 eligible enrollees, 15,292 (2.4%) developed OAG. After adjustment for confounding factors including selective serotonin reuptake inhibitors and tricyclic antidepressants, each additional month of bupropion was associated with a 0.6% reduced risk of OAG (HR = 0.994, [95% CI: 0.989-0.998], p=0.007). Compared to nonusers, 36-48 months of bupropion use was associated with a 22% reduced hazard (HR = 0.78, [95% CI: 0.60-1.00]; p=0.05) of OAG (p for trend=0.007). This association did not differ among persons with vs. without depression (p-interaction =0.65).
These findings suggest that bupropion use may be beneficial in reducing the risk of OAG. If prospective studies confirm the findings of this analysis, this may identify novel therapeutic targets for OAG and explain why disease progresses in some patients despite normalization of intraocular pressure.
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