Association between silymarin and age-related macular degeneration in patients with liver dysfunction: a nationwide cohort study

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We investigated the association between silymarin use and age-related macular degeneration (AMD) in patients with liver dysfunction using data from the Taiwan National Health Insurance Research Database from 2000 to 2021. Patients with liver dysfunction were classified into silymarin users and non-users, followed by 1:4 propensity score matching. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs), and Kaplan-Meier analysis was performed to compare cumulative AMD incidence. AMD subtype analyses and lag-time sensitivity analyses were also conducted. A total of 4,965 silymarin users and 19,860 matched non-users were included. The incidence of AMD was lower in the silymarin group than in the non-silymarin group (7.33% vs. 9.24%, P < 0.001). Kaplan-Meier analysis showed a lower cumulative incidence of AMD among silymarin users (log-rank P < 0.001). Silymarin use was associated with a lower risk of AMD (aHR = 0.846, P = 0.001), including both wet AMD (aHR = 0.772, P < 0.001) and dry AMD (aHR = 0.852, P = 0.004). A lower risk of transition from dry to wet AMD was also observed among silymarin users. Similar associations were identified in lag-time sensitivity analyses. Further prospective studies are warranted to clarify this association and its potential clinical implications.

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