Fenofibrate Protects Against Diabetic Retinopathy

Patients with type 2 diabetes given fenofibrate for lipid lowering required significantly less laser treatment for retinopathy, investigators reported.

Anthony Keech, M.D., of the University of Sydney, reported that, five years of fenofibrate therapy reduced the rate of laser intervention for macular edema by 31% and for proliferative retinopathy by 30% compared with placebo,
The improvement, which was limited to patients with a history of retinopathy, was unaffected by baseline lipid levels or the magnitude of reduction in lipid levels, suggesting a nonlipid mechanism of action.
"The retinal benefits argue for consideration of using fenofibrate in the management of diabetic eye disease," the authors concluded.
Elevated serum lipid levels have been linked to the risk and severity of diabetic retinopathy, the authors noted. Additionally, several studies have found higher lipid levels associated with macular edema and proliferative retinopathy.
The benefits of lipid-lowering therapy, however, have remained unclear. Statins proved unsuccessful for preventing diabetic retinopathy. On the other hand, small studies of PPAR-α agonists (fibrates) showed beneficial effects on macular edema and macular hard exudates, the authors continued.
Dr. Keech and colleagues reviewed data from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study, which examined almost 10,000 patients with type 2 diabetes. The trial evaluated fenofibrate’s ability to reduce the risk of macrovascular and microvascular events compared with placebo (Lancet 2005; 366: 1849-1861).
The analysis showed that treatment with fenofibrate reduced the risk of a first laser treatment from 4.9% in the placebo group to 3.4%. The difference translated into a hazard ratio of 0.69, representing a 31% reduction in the relative risk of laser treatment (P=0.0002).
Treatment with fenofibrate did not reduce the risk of a two-step progression in retinopathy in the entire cohort or in the subgroup of patients without retinopathy at baseline. In contrast, patients with pre-existing retinopathy had a significant reduction in risk with fenofibrate compared with placebo (3.1% versus 14.6%, P=0.004).
"The substantial benefits of fenofibrate on the need for laser treatment for diabetic retinopathy are likely to be additive to those benefits arising from tight control of blood glucose and blood pressure in the management of type 2 diabetes, and emerge rapidly after treatment is commenced," the authors concluded.
Practice Pearl:
Explain to interested patients that treatment with the lipid-lowering agent might reduce risks associated with diabetic retinopathy in patients with type 2 diabetes.

Keech AC, et al "Effect of fenofibrate on the need for laser treatment for diabetic retinopathy (FIELD study): a randomized controlled trial" Lancet 2007; DOI: 10.1016/S0140-6736(07)61607-9.