Rates of Nonexudative and Exudative Age-Related Macular Degeneration among Asian American Ethnic Groups

Significant differences in rates of nonexudative AMD were noted among persons of different Asian ethnicities. Chinese Americans had a 63% increased risk for nonexudative AMD, whereas Japanese Americans had a 29% reduced risk for nonexudative AMD

Bupropion use and risk of open-angle glaucoma among enrollees in a large U.S. managed care network.

Tumor Necrosis Factor (TNF) mediates retinal ganglion cell death in glaucoma. Anti-TNF drugs are neuroprotective in an animal model of glaucoma. It is unclear whether medications with anti-TNF properties such as bupropion have an impact on the risk of developing open-angle glaucoma (OAG) in humans. The purpose of this study is to determine whether bupropion use alters the risk of developing OAG.Claims data for beneficiaries age ≥35 years with no pre-existing OAG enrolled in a large nationwide U.S. managed care network continuously for ≥4 years between 2001-2011 was analyzed to identify patients who had been newly-diagnosed with OAG. The amount of bupropion use as captured from outpatient pharmacy claims over a four-year period was also quantified for each beneficiary. Multivariable Cox regression modeling assessed the impact of bupropion and other antidepressant medications on the risk of developing OAG with adjustment for sociodemographic characteristics of the enrollees along with medical and ocular comorbidities.Of 638,481 eligible enrollees, 15,292 (2.4%) developed OAG. After adjustment for confounding factors including use of other antidepressant medication classes, each additional month of bupropion use was associated with a 0.6% reduced risk of OAG (HR = 0.994, (95% CI: 0.989-0.998), p = 0.007). Compared to nonusers, those with 24-48 months of bupropion use had a 21% reduced hazard (HR=0.79, (CI: 0.65-0.94), p = 0.0099) of OAG. This association did not differ among persons taking bupropion for depression or for other reasons (p-interaction = 0.82). There was no significant association between use of tricyclic antidepressants (HR = 1.000, (CI: 0.997-1.004), p = 0.95) or selective serotonin reuptake inhibitors (HR = 0.999, (CI: 0.997-1.001), p = 0.39) and development of OAG.These findings suggest bupropion use may be beneficial in reducing the risk of OAG. If prospective studies confirm the findings of this analysis, this may identify a novel therapeutic target for OAG

Sample selection process.

<p>Sample selection process for identifying elgible enrollees for the analysis.</p

Sample selection process.

<p>Sample selection process for identifying elgible enrollees for the analysis.</p

Hazard of developing open-angle glaucoma as a function of duration of bupropion use.

<p>Controlled for selective serotonin reuptake inhibitors, tricyclic antidepressant use, age, sex, race, income, region of residence, urban/rural residence, medical diseases (hypertension, hypotension, myocardial infarction, diabetes mellitus, sleep apnea, osteoarthritis, depression), ocular diseases (cataract extraction, diabetic retinopathy, retinal venous occlusive disease), and an interaction between sex and depression.</p><p>Hazard of developing open-angle glaucoma as a function of duration of bupropion use.</p

Multivariable analysis: risk factors for open-angle glaucoma^*.

<p>^* Multivariable regression analysis controlled for the following variables: age, sex, race, household income, region of residence, urban or rural residence, osteoporosis, retinal vascular occlusion, sleep apnea, depression, diabetes mellitus, hypertension, myocardial infarction, cataract, hypotension, non-proliferative and proliferative diabetic retinopathy, pseudophakia/aphakia, and an interaction between sex and depression.</p><p>^{^} Reference group: non-Hispanic whites.</p><p>^† Reference group: <$30,000.</p><p>^♦ risk reduction for every additional 1 month of medication consumption. For example, every additional 1 month use of bupropion is associated with a 0.6% reduced hazard of developing open-angle glaucoma.</p><p>HR, Hazard Ratio; CI, Confidence Interval; OAG, Open-Angle Glaucoma; SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic antidepressant.</p><p>Multivariable analysis: risk factors for open-angle glaucoma<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0123682#t003fn001" target="_blank">^*</a>.</p