June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Nicotinamide Riboside for Progressing Glaucoma: A Double-blind, Parallel Group, Randomized, Placebo-controlled Trial – A Report on Neuroenhancement
Author Affiliations & Notes
  • Christopher Kai-Shun Leung
    Ophthalmology, The University of Hong Kong, Hong Kong, Hong Kong
  • Philip Guu
    Ophthalmology, The University of Hong Kong, Hong Kong, Hong Kong
  • Marco Yu
    Singapore Eye Research Institute, Singapore, Singapore
  • Gilda Lai
    Ophthalmology, The University of Hong Kong, Hong Kong, Hong Kong
  • Footnotes
    Commercial Relationships   Christopher Leung Santen, AbbVie, Janssen, Topcon, Alcon, Code C (Consultant/Contractor), Carl Zeiss Meditec, Tomey, Topcon, Heidelberg Engineering, Alcon, Code F (Financial Support), AIROTA Diagnostics Limited, ACE VR Limited, Code O (Owner), Carl Zeiss Meditec, Heidelberg Engineering, Code P (Patent), Carl Zeiss Meditec, Heidelberg Engineering, Topcon, Tomey, AbbVie , Code R (Recipient); Philip Guu None; Marco Yu None; Gilda Lai None
  • Footnotes
    Support  Hong Kong Health and Medical Research Fund 06171076
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 4349. doi:
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      Christopher Kai-Shun Leung, Philip Guu, Marco Yu, Gilda Lai; Nicotinamide Riboside for Progressing Glaucoma: A Double-blind, Parallel Group, Randomized, Placebo-controlled Trial – A Report on Neuroenhancement. Invest. Ophthalmol. Vis. Sci. 2023;64(8):4349.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Declining nicotinamide adenine dinucleotide (NAD) levels has been implicated in many neurodegenerative diseases including glaucoma - the leading cause of irreversible blindness. Restoring NAD levels with nicotinamide riboside (NR), an NAD precursor, in dysfunctional retinal ganglion cells may improve or stabilize visual function, but evidence about the efficacy and safety of NR in patients with glaucoma is lacking. This study investigated whether oral supplementation with NR could improve visual field (VF) sensitivity in patients with progressing glaucoma

Methods : This randomized, double-blind, parallel-group, placebo-controlled, phase 2 superiority trial was conducted at three university-affiliated ophthalmology clinics in Hong Kong. Treated but progressing glaucoma patients were randomized (1:1) by minimization to receive oral supplementation with NR (300mg/day) or placebo. Three VF tests were performed at baseline and three at week-4; change in VF sensitivity, the main outcome measure, was analyzed using intention-to-treat analysis.

Results : 118 patients with progressing glaucoma were randomly assigned to NR (n=61) or placebo (n=57). The baseline (15.6 vs 16.5 mmHg, P=0.185) and week-4 IOP (15.1 vs 15.7 mmHg, P=0.308) was comparable between the groups. At week 4, the VF MD, decreased by 0.29 dB (95% CI:0.08-0.50; P=0.006) in the placebo group; no significant change was detected in the NR group (-0.13 dB, 95% CI:-0.33-0.06, P=0.185). Ten (18.5%) and 3 (5.6%) of the 54 VF locations showed significant decreases in VF sensitivity, respectively. No significant changes of RNFL thickness were detected in the NR group or the placebo group at week 4. Two patients, one in each group, developed gastrointestinal upset.

Conclusions : NR averted VF sensitivity worsening in progressing glaucoma although it did not show a neuroenhancement effect.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Before and after plots of VF MD – placebo versus NR. Patients had three VF tests at baseline and three VF tests at week 4. The best-performing (A), moderate-performing (B), and worst-performing (C) VF tests, ranked by the MD values of individual eyes, were compared between baseline and week 4. The upper panel shows MD values for individual eyes; the lower panel shows the mean MD values of the groups.

Before and after plots of VF MD – placebo versus NR. Patients had three VF tests at baseline and three VF tests at week 4. The best-performing (A), moderate-performing (B), and worst-performing (C) VF tests, ranked by the MD values of individual eyes, were compared between baseline and week 4. The upper panel shows MD values for individual eyes; the lower panel shows the mean MD values of the groups.

 

Change of VF sensitivity (dB) at the 54 locations of the 24-2 VF test after 4 weeks of placebo (A) or NR (B) treatment.

Change of VF sensitivity (dB) at the 54 locations of the 24-2 VF test after 4 weeks of placebo (A) or NR (B) treatment.

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