A research team led by the Department of Medicine, under the School of Clinical Medicine, LKS Faculty of Medicine of the University of Hong Kong (HKUMed), has synergised impacts of worldwide clinical trial data through a series of meta-analyses on GLP‑1 receptor agonists, an emerging cardiometabolic drug, offering in-depth insights into its safety profile and novel therapeutic potential in treating cardiovascular diseases. The study found that there was no definite risk of ischaemic optic neuropathy associated with GLP-1 agonist use in patients with diabetes or heart diseases. It also revealed that cardiac patients with obesity may improve the long-term success rate of curative catheter ablation for atrial fibrillation by adopting various weightcontrol measures, along with appropriate medication. These findings will help frontline clinicians perform more comprehensive risk‑benefit assessments before prescribing medications.
HKUMed study finds no clear link between GLP‑1 use and ischaemic optic neuropathy, and shows that obese cardiac patients may improve long‑term atrial fibrillation ablation outcomes through weight control along with appropriate medication. Photo source: HKUMed
Data from over 80,000 patients show no significant optic nerve risk from GLP-1 therapy
GLP-1 receptor agonists are an emerging class of therapeutics for treating obesity, diabetes and cardiometabolic diseases. As their clinical use continues to expand, concerns about their potential side effects have emerged. Previous research indicated a possible link between GLP-1 receptor agonists and ischaemic optic neuropathy, a serious ocular complication that can cause sudden, painless vision loss and visual field defects, particularly among individuals with diabetes and hypertension. However, evidence regarding this risk has remained inconsistent and at times conflicting.
In view of this, HKUMed conducted a meta-analysis to evaluate the safety profile and therapeutic potential of GLP-1 receptor agonists. The team analysed global clinical trial data comprising more than 80,000 patients with diabetes and heart disease, representing the largest sample size examined in this field to date. The findings showed no significant association between the use of GLP-1 receptor agonists and the risk of adverse vision-threatening complications, providing clearer evidence for formulating clinical treatment plans and enabling doctors to comprehensively assess the benefits and risks of these medications.
Integrated weight management and medication improve surgical success
Obesity increases the risk of developing cardiovascular diseases, such as atrial fibrillation (AF), which is the most common cardiac arrhythmia encountered in clinical practice and can result in life-threatening complications, including stroke and heart failure. In another study, the team analysed data from 5,415 patients with atrial fibrillation and found that for individuals with obesity, every 1% reduction in weight was associated with a 6.3% reduction in the relative risk in AF recurrence after catheter ablation. This highlights that sustained weight control is a critical factor in operative success.
Cardiac patients with obesity may improve the long-term success rate of catheter ablation for atrial fibrillation though a holistic approach to weight control, including adopting a healthier lifestyle and incorporating other clinical interventions, together with GLP-1 receptor agonists. Optimal treatment outcomes require patients to adopt a comprehensive cardiovascular risk management strategy, rather than relying solely on medication.
The findings were published in the latest issue of Diabetes Care, which is the journal of the American Diabetes Association, and were presented at the European Heart Rhythm Association Congress in Vienna in 2025.
Data‑driven insights help doctors evaluate new drugs
Lead investigator Dr Will Chan Yap-hang, Clinical Assistant Professor, Department of Medicine, School of Clinical Medicine, HKUMed, said, ‘Our meta-analysis of clinical trial data provides important evidence regarding both the safety profile and novel use of GLP-1 receptor agonists in cardiovascular patients. This will help doctors more comprehensively evaluate the potential risks and benefits of prescribing these medications. However, this research does not completely rule out the possibility of rare adverse complications. Clinicians must exercise careful judgement based on each patient’s condition. It is essential not to overemphasise the potential benefits while overlooking the associated risks, and to always assess the situation holistically.’
About the research team
This interdisciplinary study was co-led by Dr Will Chan Yap-hang, Clinical Assistant Professor, and Professor Tse Hung-fat, Chair Professor and Department Chairperson, both from the Department of Medicine, School of Clinical Medicine, HKUMed. The first author is Ms Kathleen Li Hoi-ying. Other team members include Professor Yiu Kai-hang, Clinical Professor, Department of Medicine, and Dr Kendrick Co Shih, Clinical Associate Professor of Practice, Department of Ophthalmology, both from the School of Clinical Medicine, HKUMed.
HKUMed evaluates the safety profile and therapeutic potential of GLP-1 receptor agonists by analysing global clinical trial data comprising more than 80,000 patients with diabetes and heart disease. The research is led by Dr Will Chan Yap-hang (second right) and Professor Tse Hung-fat (middle). Photo source: HKUMed
Lung cancer is one of the most common cancers in Hong Kong and carries the highest mortality rate, not only locally but also globally. Professor Rina Hui, Director of the Centre for Cancer Medicine at the University of Hong Kong (HKU), said that cancer treatment is advancing at an unprecedented pace, with new breakthroughs emerging almost every fortnight. These include antibody-drug conjugates (ADCs) that are often referred to as "smart chemotherapy", T-cell engagers, and bispecific antibodies, which combine two different antibodies.
With such rapid progress, the curriculum at HKU’s Li Ka Shing Faculty of Medicine (HKUMed) needs to keep pace. About a year and a half ago, the faculty launched an eight-month integrated cancer medicine course to equip medical students with the latest clinical cancer technologies.
Professor Rina Hui, Director of the Centre for Cancer Medicine at the University of Hong Kong (HKU), Photo by Bastille Post
Professor Hui told Bastille Post that, in Hong Kong, besides lung cancer, the most common cancers include colorectal, breast, and prostate cancer. But lung cancer remains the biggest challenge, since its mortality rate is higher than the other three combined.
She said that besides smoking, other risk factors for lung cancer include second‑hand smoke, the second largest contributor, as well as family history, air pollution, kitchen fumes, occupational exposure (e.g., asbestos and radon), and prior radiotherapy. Smoking, however, remains by far the leading cause.
EGFR Mutations Common in HK Lung Adenocarcinoma
Professor Hui noted that Hong Kong's smoking rate has dropped to 8.5%, according to the latest figures released by the Health Bureau in April. While smoking‑related cancers like small cell lung cancer and squamous cell carcinoma are declining, lung adenocarcinoma is increasing, with half of patients carrying EGFR mutations. "Knowing the cancer type and genetic status is the first step for effective treatment," she said.
She also emphasised that the earlier one quits smoking, the lower the risk of getting cancer. "Quitting need not be abrupt. Nicotine patches and chewing gum can serve as supportive aids. The essential step is to discard all cigarettes, eliminate temptation, and reframe quitting as a long‑term health investment," she advised.
Professor Hui suggested that lung cancer screening is essential for high‑risk individuals. Photo source: reference image
Lung Cancer Screening: Essential for High‑Risk Individuals
Last year, the government announced plans to commission local universities to conduct AI‑assisted lung cancer screening. Professor Hui said that HKU and CUHK are currently running relevant trials, given their importance.
"High‑risk people, like those aged 50 to 75, heavy smokers (30 pack‑years), and those exposed to second‑hand smoke, should get screened regularly," she said. "Taiwan offers a noteworthy approach, where they screen non‑smokers with a family history of lung cancer."
She acknowledged that free lung cancer screening for every individual in Hong Kong is unlikely to be feasible at this stage, due to the high costs involved. However, screening could be carried out through collaboration between the government and private healthcare providers, targeting high‑risk groups. "As I tell my patients, getting screened is like saving up to pay taxes. You're actually gaining in the long run. Early detection means better outcomes and lower treatment costs."
She said that lung cancer treatment regimens are becoming increasingly advanced. "Patients with genetic alterations can use targeted therapies; those without can benefit from immunotherapy, and survival rates have improved significantly." However, she also pointed out that lung cancer remains the world's "number one cancer killer", underscoring the urgent need for continued related research and clinical trials.
Recognising the rapid evolution of cancer treatment, HKUMed has launched an eight‑month integrated cancer medicine course starting in October 2024. Photo source: reference image
New Course to Train Future Doctors
Recognising the rapid evolution of cancer treatment, HKUMed has launched an eight‑month integrated cancer medicine course starting in October 2024, which is delivered in six cohorts per year, ensuring that future doctors stay abreast of the latest developments. "We bring together surgeons, researchers, public health experts, oncologists (including medical oncologists and radiation oncologists), pathologists, and radiologists to teach medical students the basics of immunotherapy, targeted therapies, smart chemotherapy, and radiation, so that no matter what field they go into, they'll be able to handle cancer patients when they see them," she said.
New Cancer Treatments Bring New Hope
Beyond well‑established immunotherapy, Professor Hui highlighted emerging treatments:
One is called Antibody‑Drug Conjugate (ADC), often referred to as "smart chemotherapy" or "missile‑guided chemotherapy." "The antibody carries the chemotherapy drug, entering cancer cells with precision like a missile. When the linker dissolves, it releases the drug directly into the cancer cells, killing them effectively," she explained.
She noted that ADCs have now been proven to benefit patients with stage IV metastatic cancer. Clinical trials are currently combining these drugs with immunotherapy, and data have already shown effectiveness in early‑stage triple‑negative breast cancer patients.
Another future trend in cancer treatment is bispecific antibodies, which combine two different antibodies with fewer side effects and a synergistic effect. For example, VEGF bispecific antibodies combine the dual mechanisms of immune checkpoint inhibitors and anti‑angiogenic therapy, and have already shown effectiveness in cancers such as lung and breast cancer. Combining two targeted drugs also results in fewer side effects and better treatment outcomes for lung cancer patients.
T‑Cell Engagers: A Breakthrough for Small Cell Lung Cancer
Professor Hui also mentioned a new treatment trend called T-cell engagers. "For example, a therapy targeting DLL3 on the surface of small cell lung cancer cells — on one side, it targets DLL3, and on the other side, it attracts the immune system's T-cells, which act like soldiers attacking the cancer cells together. This type of drug is already on the market and has been shown to improve overall survival in extensive-stage small-cell lung cancer. Clinical trials are currently exploring its use in first-line treatment and for stage III patients," she explained.
However, she pointed out that targeted therapy remains a future priority. Since many cancers occur due to genetic alterations, if the genes driving cancer growth can be identified, targeted medications can be utilized and show improved therapeutic efficacy across various cancers. For example, 60% to 70% of breast cancers are hormone receptor-positive, and of those, 30% to 40% have PIK3CA gene mutations. "The corresponding targeted drugs are currently available in Hong Kong, but they are expensive. There is now a phase III clinical trial in which patients can use this type of medication for free, and may even have access to better new drugs. However, patients need to undergo genetic sequencing to confirm whether they have the corresponding genetic mutation before they can participate in the relevant trial," she said.
According to Professor Hui, since many cancers occur due to genetic alterations, if the genes driving cancer growth can be identified, targeted medications can be utilized and show improved therapeutic efficacy across various cancers. Photo by Bastille Post
