Fenofibrate use was associated with less progression to vision-threatening retinopathy

Design

Retrospective propensity-matched cohort, TriNetX database

Population

Adults with diabetes and mild or moderate NPDR, with vs without fenofibrate (about 4,300 per group)

Primary outcome

Progression to vision-threatening DR, DME, cataract, POAG

Effect

VTDR OR 0.53 (0.33-0.84); DME OR 0.32 (0.24-0.41); cataract OR 0.59 (0.44-0.77)

This retrospective TriNetX cohort identified adults with diabetes and mild or moderate non-proliferative diabetic retinopathy between 2014 and 2024, and propensity matched those prescribed fenofibrate with those who were not (about 4,000-4,600 per group for each outcome).

Fenofibrate use was associated with lower odds of progression to vision-threatening retinopathy (OR 0.53, 95% CI 0.33-0.84), macular oedema (OR 0.32, 0.24-0.41) and cataract (OR 0.59, 0.44-0.77).

Randomised trials have previously suggested fenofibrate slows retinopathy progression, but it remains little used for this purpose. This real-world analysis points in the same direction.

Fenofibrate is inexpensive and widely available. For patients with non-proliferative retinopathy who also have raised triglycerides, the case for prescribing it is strengthened.

• Consider fenofibrate for patients with mild to moderate NPDR, especially with raised triglycerides.
• Coordinate with the physician; check renal function before and during treatment.
• Do not relax screening or glucose and blood pressure targets.
• Record baseline retinopathy grade so progression can be assessed.

Why it matters

An inexpensive lipid drug may slow progression to sight-threatening retinopathy but is seldom prescribed for the eye.

Don't overread it

This was observational; the very large apparent reduction in macular oedema is more than trials have shown and likely includes confounding.

The statistics, in plain English

Odds ratios of 0.3 to 0.6 are large effects for a drug, which in observational data often signals that fenofibrate users differ in unmeasured ways, such as closer medical follow-up.

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