Contrasting with prior findings: a population-based cohort study of fibrate exposure and open-angle glaucoma risk in patients with hyperlipidemia

This study investigated the association between fibrate use and the risk of open-angle glaucoma (OAG) in patients with hyperlipidemia. A nationwide retrospective cohort study was conducted using Taiwan’s Longitudinal Generation Tracking Database (LGTD 2000). Patients aged ≥ 50 years newly diagnosed with hyperlipidemia between 2001 and 2013 were included. New fibrate users were stratified by adherence, with higher proportion of days covered (PDC) users (≥ 50%) as the exposure group, while lower PDC users (20–50%) and nonusers served as comparators. Propensity score matching (1:1) created balanced cohorts, followed for up to five years. OAG risk was estimated using marginal Cox models. In matched cohorts, OAG incidence was 4.98 per 1000 person-years in higher PDC users and 3.29 in lower PDC users. Compared with nonusers, higher PDC users had 4.78 versus 2.83 per 1000 person-years. Higher PDC was not significantly associated with OAG risk versus lower PDC (adjusted hazard ratio [aHR] 1.48; 95% confidence interval [CI] 0.95–2.29), but risk was elevated compared with nonuse (aHR 1.68; 95% CI 1.09–2.61). Patients with ≥ 303 cumulative defined daily doses/year and those treated ≥ 2 years had increased risks, with aHRs of 3.75 (95% CI 2.21–6.38) and 1.70 (95% CI 1.04–2.76), both showing linear trends. Higher cumulative doses and longer duration of fibrate therapy were associated with increased OAG incidence. These findings require further evaluation, including clinical and cost-effectiveness considerations, before routine ophthalmologic surveillance is considered.