Pulmonary Arterial Hypertension Meds Could Reduce DR Incidence

Recent findings raise the possibility that systemically administered prostacyclin analogs may exert protective effects on retinal microvasculature through vasodilatory, anti-inflammatory and cytoprotective mechanisms. Photo: GSK. Click image to enlarge. A rare but severe condition, pulmonary arterial hypertension is characterized by progressive pulmonary vascular remodeling and elevated pulmonary pressures, often culminating in right heart failure and early mortality. Given overlapping vascular mechanisms between it and diabetic retinopathy (DR)—namely, endothelial dysfunction, inflammation and dysregulated vascular tone—it is plausible that prostacyclin analog treatment may provide systemic microvascular benefits extending to the retina.In a recent study published in Retina, researchers evaluated the association between prostacyclin analog therapy and the long-term incidence of DR in patients with diabetes and pulmonary arterial hypertension. Their findings demonstrated that patients with primary or secondary pulmonary arterial hypertension were associated with a reduced risk of developing DR, particularly nonproliferative DR (NPDR) and diabetes-related ophthalmic complications, over a five-year follow-up. No statistically significant difference was observed for proliferative diabetic retinopathy (PDR).“Although intraocular anti-VEGF therapies and glycemic control remain the mainstays of DR management, few systemic therapies have demonstrated direct protective effects against DR onset or progression,” the study authors wrote. “Our findings extend this paradigm by implicating systemically administered PCAs, traditionally used for pulmonary arterial hypertension, in potentially modifying the course of diabetic microvascular disease.”Before propensity score matching within the TriNetX Global Collaborative Network, the prostacyclin analog therapy group included 2,761 patients and the control group 7,321 patients. The mean ages were 60.9 and 64.7, respectively. The majority were white (60% in the prostacyclin group and 57% in controls). After matching, two well-balanced cohorts of 2,584 patients each were established. The mean ages in the matched cohorts were nearly identical (61.7 for the prostacyclin group and 61.7 for controls).Among matched cohorts, prostacyclin analog therapy was associated with a significantly lower incidence of NPDR (24 vs. 42 events; hazard ratio [HR] = 0.59) and diabetes with ophthalmic complications (65 vs. 99 events; HR = 0.67). No statistically significant difference was observed in PDR incidence (10 vs. 15 events; HR = 0.63).“Our study may help inform future directions in retinal drug development and biomarker discovery. The observed reduction in DR risk suggests a role for prostacyclin pathway modulation in retinal microvascular health,” the researchers wrote. “These findings support the rationale for further mechanistic research into prostacyclin analogs and may guide the design of future studies involving novel systemic or localized therapies targeting the same pathway.”Click here for the journal source. Lishinsky-Fischer N, Levy J. Prostacyclin analogues and diabetic retinopathy outcomes in pulmonary hypertension patients: a cohort analysis. Retina March 2, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.