From the Research
Fenofibrate at a dose of 145 mg daily is recommended to reduce the progression of diabetic retinopathy in patients with type 2 diabetes, particularly those with pre-existing retinopathy. This treatment should be considered as an adjunct to standard diabetes management, including optimal glycemic control, blood pressure management, and regular eye examinations. Patients should take fenofibrate with food to enhance absorption, and treatment is typically long-term as benefits have been observed with continued use over years. Before starting fenofibrate, baseline liver function tests and lipid profiles should be obtained, with follow-up monitoring at 3 months and then periodically. Fenofibrate works by activating peroxisome proliferator-activated receptor alpha (PPAR-α), which reduces inflammation, oxidative stress, and vascular leakage in the retina. It also has beneficial effects on lipid metabolism, decreasing triglycerides and increasing HDL cholesterol. While fenofibrate is generally well-tolerated, potential side effects include muscle pain, liver enzyme elevations, and gastrointestinal symptoms. Fenofibrate should be used cautiously in patients with severe renal impairment, with dose adjustment to alternate days if creatinine clearance is impaired, as indicated in the study 1.
The most recent and highest quality study, published in 2024 in the NEJM evidence 1, demonstrated that fenofibrate reduced the progression of diabetic retinopathy compared to placebo, with a hazard ratio of 0.73. The study also showed that fenofibrate decreased the frequency of any progression of retinopathy or maculopathy and the development of macular edema.
Key points to consider when prescribing fenofibrate for diabetic retinopathy include:
- The dose of 145 mg daily, as used in the study 1
- The importance of regular monitoring of liver function tests and lipid profiles
- The need for caution in patients with severe renal impairment
- The potential benefits of fenofibrate in reducing the progression of diabetic retinopathy and the development of macular edema
- The overall safety profile of fenofibrate, with serious adverse events occurring in 36.1% of participants allocated fenofibrate and 35.5% of participants allocated placebo, as reported in the study 1.
In summary, fenofibrate at a dose of 145 mg daily is a recommended treatment for reducing the progression of diabetic retinopathy in patients with type 2 diabetes, and should be considered as part of a comprehensive management plan, including optimal glycemic control, blood pressure management, and regular eye examinations, as supported by the study 1.