This retrospective propensity score-matched cohort study evaluated whether systemic IL-6 inhibitor use reduces the risk of incident diabetic retinopathy (DR), DR progression, vision-threatening complications, and retinal interventions in adults with type 1 or type 2 diabetes, using the US TriNetX EHR network (2004–2026) with up to 5-year follow-up.
IL-6 inhibitor use was associated with significantly lower 5-year risks of NPDR (RR 0.50), PDR (RR 0.47), DME (RR 0.37), and vitreous hemorrhage (RR 0.41) vs. matched controls; anti-VEGF, PRP, and PPV rates were also lower; no significant difference was seen for neovascular glaucoma.
Retrospective EHR-based design limits causal inference; residual confounding from unmeasured variables (e.g., glycemic control trends, disease severity) is possible; DR outcomes rely on diagnostic coding accuracy rather than standardized ophthalmic grading.
Systemic IL-6 inhibitors in diabetic patients may offer a protective effect against DR onset and progression, but prospective trials are needed before incorporating IL-6 pathway modulation into routine diabetic eye disease management.
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