Clinical course and tolerability of glucagon-like peptide-1 receptor agonists in ocular inflammatory disease

Abstract

Abstract Background Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have rapidly become a therapeutic cornerstone in the management of diabetes mellitus and obesity. Recent literature has recognized therapeutic effects of GLP-1RAs, including systemic immunomodulatory and anti-inflammatory properties. We describe the clinical course and tolerability of GLP-1RAs in patients with pre-existing ocular inflammatory disease (OID). Methods In this retrospective descriptive study, we selected patients from a tertiary eye center with a diagnosis of noninfectious uveitis, scleritis, or retinal vasculitis who received GLP-1RA treatment for a diagnosis of diabetes mellitus (DM), obesity, or both. Patient data was recorded, including age, sex, ocular diagnosis, systemic comorbidities, concomitant medications, adverse events, and clinical status. Patients were followed longitudinally, and clinical findings were recorded at subsequent visits if available (6-months, 1-, and 3-year time points). Results A total of 49 eyes from 29 patients with OID were included. The mean age was 57.3 ± 10.8 years with a female predominance of 65.5%. Indications for GLP-1RA initiation were DM (10.3%), obesity (41.4%), and comorbid DM and obesity (48.3%). OID diagnoses included panuveitis (48.9%), anterior uveitis plus scleritis (16.3%), anterior uveitis (14.3%), retinal vasculitis plus uveitis (8.2%), retinal vasculitis (8.2%), and intermediate uveitis (4.1%). Initial GLP-1RA therapy included semaglutide (89.7%), tirzepatide (3.4%), liraglutide (3.4%), and dulaglutide (3.4%). Prior to GLP-1RA initiation, nine eyes showed signs of active uveitis while 40 eyes were clinically inactive. At subsequent 6-month, 1-year, and 3-year follow-up after GLP-1RA initiation, active disease was observed in five of 43, five of 47, and one of 37 evaluable eyes. Over the 3-year review period, nine of the 14 patients on corticosteroids tapered/discontinued steroid therapy, as did three of 12 patients on antimetabolites and four of seven patients receiving biologics. Fifteen adverse events were reported in 11 patients (37.9%), with gastrointestinal symptoms (four patients) and worsened glycemic control (two patients) among the most frequently reported. Conclusion Ocular inflammatory activity remained largely stable over the observation period. However, a direct causation between use of GLP-1RA and improved disease activity cannot be established. Importantly, GLP-1RA was well-tolerated with only one serious adverse event.

The authors' abstract, as published at the source. Journal of Ophthalmic Inflammation and Infection, 2026 · DOI ↗