Oral montelukast is associated with decreased odds of diabetic retinopathy

Abstract

Purpose : Recent research using experimental animal models has suggested that montelukast, a leukotriene receptor antagonist, may play a role in preventing diabetic retinopathy (DR). However, few studies have investigated its potential efficacy in humans. This case-control study was conducted to investigate whether use of oral montelukast was associated with decreased odds of DR in patients with diabetes mellitus.

Methods : Medical records of subjects presenting to a tertiary eye center between November 1, 2019 and November 1, 2020 were collected using the Institutional Cohort Finder tool and analyzed. ICD codes were used to identify patients with diabetes mellitus (E08-E13) and DR (E08.31-35/E11.31-35). Control patients (with diabetes mellitus but without DR) who presented to our center during a similar time period were used to calculate crude and adjusted odds ratios for oral montelukast. Only subjects with no missing data were analyzed in this study. Using available clinical records, patients were also assessed for the presence of DR risk factors, including elevated hemoglobin (Hb)A1c levels, smoking history, end-organ damage (i.e. diabetic nephropathy and neuropathy), hypertension, hyperlipidemia, and non-Caucasian race.

Results : A total of 563 patients with DR were evaluated at our center during the study period. In our study, 14 of the 210 (6.6%) patients were identified to have used oral montelukast prior to the diagnosis of DR, compared to 60 of 353 controls (16.9%) (univariable OR: 0.38, 95% CI: 0.21-0.68, P = 0.0012). In the multivariate logistic regression analysis, use of oral montelukast was significantly associated with decreased odds of DR (adjusted OR: 0.32, 95% CI: 0.16-0.62, P = 0.0009), as well as identification as a “never smoker” (adjusted OR: 0.49, 95% CI: 0.30-0.79, P = 0.004). Several risk factors were significantly associated with increased odds of DR, including hypertension (adjusted OR: 5.81, 95% CI: 3.62-9.33, P < 0.0001), hyperlipidemia (adjusted OR: 5.51, 95% CI: 3.39-8.95, P < 0.0001), and higher HbA1c (OR 1.35, 95% CI: 1.21-1.51, P < 0.0001).

Conclusions : Use of oral montelukast is associated with decreased odds of DR in patients with diabetes mellitus; subjects with DR are less likely to have consumed oral montelukast. Given the role of chronic inflammation in the pathophysiology of DR, these protective benefits may be related to montelukast’s anti-inflammatory properties.

This is a 2021 ARVO Annual Meeting abstract.