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Anthony P Khawaja, Thaddeus P Dryja, Zhongyuan Wei, Dongying Song, Haijun Tian, Kristijan Kahler, Wei Zheng; A protective association of selective serotonin reuptake inhibitors and a harmful association of calcium channel blockers for primary open-angle glaucoma identified in a healthcare database analysis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3710.
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Identifying associations between systemic medication use and primary open-angle glaucoma (POAG) may highlight new biological pathways underlying glaucoma and possibly prompt changes in standards of care. We aimed to identify associations between prescription drugs and POAG in an exploratory study of US insurance claims data.
We analysed patient-level data from Truven Health MarketScan Research databases. POAG status and drug usage were ascertained during a 2-year identification period and a preceding 5-year period respectively. To reduce misclassification bias, we required cases to have undergone a glaucoma procedure and controls to have undergone cataract surgery but without a coded glaucoma diagnosis, procedure, or medication. We used multiple logistic regression models to examine associations of POAG with all prescription drugs and classes individually. Analyses were adjusted for age, sex, geographic region of residence, employment status, insurance plan type, and the total number of drugs prescribed. We applied a Bonferroni corrected threshold for statistical significance to account for the numerous drugs and classes tested.
In total, 6272 cases and 30,650 controls were identified and selected. The median age was 72 years and 48% were men. We examined associations between POAG status and 844 generic drugs and 292 drugs classes, yielding a Bonferroni threshold for statistical significance of P < 4.4 x 10-5. Selective serotonin reuptake inhibitors (SSRIs) were strongly associated with a reduced risk of POAG (OR [95% CI] 0.70 [0.64-0.76], P = 1.0 x 10-15); the most significant drug in this class was citalopram (OR [95% CI] 0.66 [0.57-0.77], P = 1.2 x 10-7). Calcium channel blockers (CCBs) were strongly associated with an increased risk of POAG (OR [95% CI] 1.26 [1.18-1.35], P = 1.8 X 10-11); the most significant drug in this class was amlodipine (OR [95% CI] 1.27 [1.18-1.37], P = 5.9 X 10-10).
We present real-world evidence for a protective association of SSRIs and a harmful association of CCBs for risk of POAG requiring a glaucoma procedure. Further research is needed to determine if these novel associations are due to as-yet-obscure roles for serotonin metabolism or calcium channels in glaucoma, or due to variations in the patterns for prescribing these drugs.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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