Diabetic retinopathy continues to be a major global health concern, given its status as one of the leading causes of preventable blindness. Despite advances in glycemic and blood pressure control, systemic treatment options that directly target DR remain limited. Against this backdrop, fibrates are emerging as a potential adjunct therapy that is both effective and accessible, particularly in resource-constrained settings.
The study, published in the Journal of Diabetes and Its Complications, was conducted by Kai-Yang Chen and colleagues from the Department of General Medicine, Chang Gung Memorial Hospital (Linkou branch), Taoyuan, Taiwan.
The review included 17 eligible studies, spanning diverse populations and study designs. The analysis highlighted that fenofibrate, in particular, exerted the most consistent protective effect, especially when prescribed in the early stages of DR. This reinforces earlier evidence from landmark trials such as FIELD and ACCORD Eye, where fibrates demonstrated benefits beyond lipid-lowering, extending to microvascular protection.
Key Findings:
- Fibrate therapy lowered the incidence of diabetic retinopathy (DR) by 28% compared to placebo.
- It reduced the long-term progression of DR by 33%.
- The addition of fibrates to standard statin therapy further reduced DR progression by 17% compared to fibrates alone.
- Although the reduction in risk of progression to proliferative DR was not statistically significant, the trend still favored fibrate use.
- No increase in serious adverse events or overall mortality was observed, highlighting a neutral safety profile.
- The pooled data confirmed no significant difference between fibrates and placebo in terms of all-cause mortality or severe adverse events, providing reassurance about safety.
The authors emphasize that the therapeutic effect was most pronounced in earlier stages of disease, highlighting the importance of timely intervention. They also note that while fibrates may not completely prevent progression to advanced proliferative DR, the delay in disease course itself could have major clinical and socioeconomic benefits by reducing the need for invasive treatments such as laser therapy or intravitreal injections.
The large-scale review provides robust evidence that fibrate therapy—especially fenofibrate—substantially lowers the risk of diabetic retinopathy onset and slows disease progression in patients with diabetes. With a favorable safety profile and affordability, fibrates could represent a valuable addition to current management strategies, reshaping the therapeutic landscape for diabetic eye disease.
Reference:
Chen, K., Chan, H., & Chan, C. (2025). Can fibrate therapy redefine the management of diabetic retinopathy? A comprehensive systematic review and meta-analysis of efficacy and safety. Journal of Diabetes and its Complications, 39(11), 109178. https://doi.org/10.1016/j.jdiacomp.2025.109178
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