Association between amiodarone use and risk of cataract: a population-based active-comparator study

Sheng-Yin To; Hsin-Ting Lin; Chun-Cheng Liao; Ke-Ting Pan; Yuan-Liang Wen; Senyeong Kao; Li-Ting Kao

doi:10.1093/postmj/qgae034

Association between amiodarone use and risk of cataract: a population-based active-comparator study

Postgrad Med J. 2024 Mar 20:qgae034. doi: 10.1093/postmj/qgae034. Online ahead of print.

Authors

Sheng-Yin To^{1

2

3}, Hsin-Ting Lin^{4

5}, Chun-Cheng Liao^{6

7

8}, Ke-Ting Pan^{9

10}, Yuan-Liang Wen^{1

2}, Senyeong Kao^{1

3}, Li-Ting Kao^{1

2

11}

Affiliations

¹ Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 114, Taiwan.
² School of Pharmacy, National Defense Medical Center, Taipei 114, Taiwan.
³ School of Public Health, National Defense Medical Center, Taipei 114, Taiwan.
⁴ Department of Ophthalmology, National Defense Medical Center, Tri-Service General Hospital, Taipei 114, Taiwan.
⁵ National Defense Medical Center, Graduate Institute of Medical Sciences, Taipei 114, Taiwan.
⁶ Department of Family Medicine, Taichung Armed Forces General Hospital, Taichung 411, Taiwan.
⁷ Department of Medical Education and Research, Taichung Armed Forces General Hospital, Taichung 411, Taiwan.
⁸ School of Medicine, National Defense Medical Center, Taipei 114, Taiwan.
⁹ Bartlett School, Institute of Environmental Design and Engineering, UCL, London, WC1E 6BT, United Kingdom.
¹⁰ National Defense Medical Centre, Graduate Institute of Aerospace and Undersea Medicine, Taipei 114, Taiwan.
¹¹ Department of Pharmacy Practice, Tri-Service General Hospital, Taipei 114, Taiwan.

PMID: 38507113
DOI: 10.1093/postmj/qgae034

Abstract

Background: Despite previous concerns about ocular side effects related to amiodarone, the relationship between amiodarone and cataract remains uncertain. Therefore, this study aimed to assess the potential association between amiodarone use and the subsequent risk of cataract, taking into account potential confounders.

Methods: This population-based, active comparator-controlled cohort study utilized the data from the Taiwan National Health Insurance program and involved adults over 40 years old between 2001 and 2013. We analyzed 12 055 new amiodarone users and contrasted them with a propafenone user cohort. The primary outcome was the incidence of cataract. Inverse-probability treatment-weighting (IPTW) was further used to eliminate the potential confounding effects, and Cox proportional-hazard regression analyses were performed to calculate the risk of cataract. Serial subgroup analyses were also performed.

Results: In the main analysis, amiodarone users did not exhibit a significant causal relationship in both full cohort [adjusted hazard ratio (aHR): 0.994, 95% confidence interval (CI): 0.913-1.082] and IPTW cohort (IPTW-aHR 0.977, 95% CI: 0.900-1.060). Furthermore, it is important to highlight a significantly reduced risk of cataract among patients with heart failure (IPTW-aHR 0.708, 95% CI: 0.554-0.905) and during the 2-year follow-up period (IPTW-aHR 0.889, 95% CI: 0.794-0.996), implying potential advantages linked to the use of amiodarone.

Conclusions: The study found no increased risk of cataract with amiodarone, one of the most frequently used antiarrhythmic medications, compared to the use of propafenone. Future research is recommended to explore potential mechanisms and their implications for clinical practice.

Keywords: active comparator; amiodarone; cataract; heart failure; population-based; propafenone.