TOPLINE

Adults with mild or moderate nonproliferative diabetic retinopathy on fenofibrate had nearly half the odds of progressing to vision-threatening disease, more than 40% lower odds of developing cataracts, and over two-thirds lower odds of developing diabetic macular edema compared with those not on the drug.

METHODOLOGY

• This retrospective cohort study, aimed at evaluating whether the lipid-lowering drug fenofibrate could slow the progression of diabetic eye disease, drew on a decade of real-world data (2014-2024) from the TriNetX international database, involving adult patients aged 18-90 years with diabetes and hypertriglyceridemia.
• A total of 4316 users of fenofibrate with mild or moderate nonproliferative diabetic retinopathy were compared with 4316 matched nonusers for progression to vision-threatening diabetic retinopathy; separate matched cohorts were analyzed for the development of cataracts (4200 per group), primary open-angle glaucoma (4073 per group), and diabetic macular edema (4571 per group).
• Across all cohorts, the mean age ranged from 64.8 to 65.9 years, and approximately 60% of the patients were men in both the fenofibrate and non-fenofibrate groups.
• Those with preexisting severe nonproliferative diabetic retinopathy, proliferative diabetic retinopathy, cataracts, glaucoma, or diabetic macular edema were excluded from their respective cohorts.

TAKEAWAY

• Patients taking fenofibrate had around 47% lower odds of progression to vision-threatening diabetic retinopathy than those not taking fenofibrate (odds ratio [OR], 0.528; P = .0059).
• The use of fenofibrate was associated with slightly more than 40% lower odds of developing cataracts (OR, 0.585; P = .0002), particularly in patients aged 51 years or older.
• Those taking fenofibrate had nearly 68% lower odds of developing diabetic macular edema (OR, 0.316; P < .0001).

IN PRACTICE

"[The study] findings provide supportive evidence for the beneficial effects of fenofibrates and suggest this class of medications as a cost-effective and accessible option to lower the risk of long-term ocular complications," the researchers reported.

SOURCE

The study was led by Courtney Oliver, of the Drexel University College of Medicine in Philadelphia. It was published online on August 21 in British Journal of Ophthalmology.

LIMITATIONS

As a retrospective study relying on medical record codes, accuracy depended on how consistently diagnoses were recorded in the database. The database could confirm a fenofibrate prescription was issued but not whether patients continued taking it or for how long. Despite efforts to account for triglyceride levels in matching, this variable remained imbalanced between groups.

DISCLOSURES

One author was supported by a Wilmer Rising Professorship, and another author was supported by Dracopoulos and Hankins Uveitis Funds. 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.