Fenofibrate Use Benefits Patients With Diabetic Retinopathy: JAMA

Diabetic retinopathy (DR) may progress from nonproliferative DR (NPDR) to vision-threatening DR (VTDR). Previous studies on fenofibrate use, as a protective measure, have conflicting results, and fenofibrate is not typically considered by ophthalmologists in the management of DR currently. Therefore, Dr Elana Meer and her team conducted a study to assess the association between fenofibrate use and the progression from NPDR to VTDR, proliferative DR (PDR), or diabetic macular edema (DME).

In this multicenter cohort study, the researchers used medical claims data from a large US insurer. They created cohorts from all patients with NPDR 18 years or older who had laboratory values from January 1, 2002, to June 30, 2019. The major outcomes assessed were a new diagnosis of VTDR (a composite outcome of either PDR or DME) or DME and PDR individually. They used the time-updating model for all covariates in multivariate Cox proportional hazard regression to determine the hazards of progressing to an outcome. Additional covariates assessed were NPDR severity scale, systemic illnesses, demographics, kidney function (based on estimated glomerular filtration rate level), hemoglobin A1c, hemoglobin, and insulin use.

Key findings of the study:

• The researchers included a total of 5835 fenofibrate users with NPDR and 144 417 fenofibrate nonusers.
• Among these, they noted that 27 325 (18.2%) progressed to VTDR, 4086 (2.71%) progressed to PDR, and 22 750 (15.1%) progressed to DME.
• After controlling for all covariates, they found that fenofibrate is associated with a decreased risk of VTDR (hazard ratio, 0.92 ) and PDR (hazard ratio, 0.76 but not DME (hazard ratio, 0.96).

The authors concluded, "In this study, fenofibrate use was associated with a decreased risk of PDR and VTDR but not DME alone. These findings support the rationale for additional clinical trials to determine if these associations may be representative of a causal relationship between fenofibrate use and reduced risk of PDR or VTDR."

For further information:

DOI: 10.1001/jamaophthalmol.2022.0633