TOPLINE

Patients with type 2 diabetes who received common anti-inflammatory drugs — prednisone, ibuprofen, or cetirizine — had a 37%-64% lower risk of developing vision-threatening complications of diabetic retinopathy than nonusers. This risk reduction matched that of fenofibrate (a drug already known to protect diabetic eyes) but was absent with gabapentin (a pain medication with no anti-inflammatory activity), supporting a link to inflammation control.

METHODOLOGY

• Researchers analyzed health records of patients with type 2 diabetes from the TriNetX US Collaborative Network to determine whether those who took common anti-inflammatory drugs — cetirizine, ibuprofen, or prednisone — had lower rates of two serious diabetic eye complications, diabetic macular edema and proliferative diabetic retinopathy.
• Adults aged 18 years or older with type 2 diabetes and documented eye care were included if they had two documented uses of cetirizine, ibuprofen, prednisone, fenofibrate, or gabapentin between January 2005 and March 2025.
• Fenofibrate was included because it has already been shown in a clinical trial to protect against diabetic eye disease, and gabapentin, a pain medication without anti-inflammatory activity, served as a negative control to assess whether the findings were attributable to inflammation.
• For each drug, users were matched with nonusers based on 44 factors, including demographic characteristics, systemic comorbidity, baseline diabetic retinopathy severity, healthcare utilization, concomitant medications, and glycemic and metabolic markers; this resulted in matched groups ranging from 18,762 to 86,846 pairs of drug users and nonusers.
• New cases of diabetic macular edema and proliferative diabetic retinopathy were tracked for 3 years, starting from each patient's second qualifying visit; researchers also tracked eight unrelated eye conditions, including cataracts and glaucoma, that were not expected to be affected by inflammation.

TAKEAWAY

• Cetirizine treatment was associated with a 38% reduced risk for diabetic macular edema (hazard ratio [HR], 0.62; 95% CI, 0.51-0.74) and a 41% reduced risk for proliferative diabetic retinopathy (HR, 0.59; 95% CI, 0.46-0.77).
• Ibuprofen treatment was also associated with a 37% reduced risk for diabetic macular edema (HR, 0.63; 95% CI, 0.56-0.69) and a 52% reduced risk for proliferative diabetic retinopathy (HR, 0.48; 95% CI, 0.41-0.56); prednisone treatment was linked to a more than 50% reduced risk for both outcomes.
• Fenofibrate treatment was associated with risk reductions of similar magnitude for both diabetic macular edema and proliferative diabetic retinopathy, whereas gabapentin treatment was not associated with either outcome.
• The eight unrelated eye conditions had little-to-no association with cetirizine or ibuprofen use but had small, statistically significant associations with prednisone and fenofibrate use.

IN PRACTICE

"Our findings indicate that fenofibrate may not be the only oral medication associated with reduced risk of vision-threatening diabetic retinopathy…The convergence across four pharmacologically distinct anti-inflammatory medications supports the hypothesis that anti-inflammatory agents may influence the progression of diabetic retinopathy," the researchers reported.

SOURCE

The study was led by Henry S. Bison, MD, of the Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine in Baltimore. It was published online on September 10 in Ophthalmology.

LIMITATIONS

Being a retrospective study, it could not prove whether the drugs were responsible for the lower risk for diabetic eye diseases. Drug users and nonusers entered the study through slightly different types of visits. The database did not reliably record the dosages of each drug received by patients.

DISCLOSURES

The study received no funding. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.