title: Bupropion use and risk of open-angle glaucoma among enrollees in a large U.S. managed care network.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, United States of America.
authors: Joshua D
authors: JD
authors: Stein
authors: Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, United States of America.
authors: Nidhi
authors: N
authors: Talwar
authors: Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors: Jae H
authors: JH
authors: Kang
authors: Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America; Harvard School of Public Health, Harvard Medical School, Boston, Massachusetts, United States of America; Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.
authors: Olivia I
authors: OI
authors: Okereke
authors: Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States of America.
authors: Janey L
authors: JL
authors: Wiggs
authors: Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States of America.
authors: Louis R
authors: LR
authors: Pasquale
mesh_terms: D016642:Bupropion / Q000009:adverse effects*; D003695:Delivery of Health Care; D004305:Dose-Response Relationship, Drug; D005260:Female; D005902:Glaucoma, Open-Angle / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D015999:Multivariate Analysis; D012307:Risk Factors; D014481:United States
chemical_list: D016642:Bupropion