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  • Systemic Drugs and Acute Angle Closure

    By Jean Shaw
    Selected and reviewed by Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, November 2022

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    Na and Park set out to identify drugs that are associated with acute angle closure (AAC) and to evaluate the risk of AAC associated with each drug. They compiled a list of 61 drugs linked to AAC development, with sumatriptan, topiramate, and duloxetine having the highest odds of this association.

    For this study, the researchers turned to South Korea’s Health Insurance Re­view and Assessment Service database, which contains medical information for the country’s entire population. They used diagnostic and procedure codes to identify patients who were first diagnosed with AAC and treated between 2013 and 2019 (N = 13,531), and they collected information on all drugs that the study participants were prescribed as well as prescription dates up to 180 days before the onset of AAC. For each patient, the hazard period was defined as one to 30 days before AAC onset, and the time frame of 91 to 180 days before AAC onset served as the control period. The main outcome was those drugs associated with AAC and the odds of AAC development linked to each identified drug.

    All told, 949 specific drugs were prescribed during the control period; of these, 61 were found to be associated with AAC. Of the 61, the antimigraine drug sumatriptan (OR, 12.60; 95% CI, 4.13-38.44) had the highest odds, followed by the antiepileptic topira­mate (OR, 5.10; 95% CI, 2.22-11.70) and the antidepressant duloxetine (OR, 4.04; 95% CI, 2.95-5.54). In addition, several drugs not previously thought to be associated with AAC were identified, including two drugs used for gastroin­testinal issues, lactulose (OR, 2.81; 95% CI, 1.72-4.61) and metoclopramide (OR, 2.52; 95% CI, 1.95-3.25).

    The mean period from prescrip­tion of one of the 61 drugs to AAC onset was 11.9 days (range, 10.9-12.8). Of note, polypharmacy emerged as a potential issue: of those who were taking at least one of the 61 identified medications, 47% were prescribed three or more of the drugs on the list—and 9% were prescribed six or more. (Also see related commentary by Paul J. Foster, PhD, Robert Luben, PhD, and Anthony P. Khawaja, PhD, in the same issue.)

    The original article can be found here.