TY - JOUR
T1 - Fenofibrate for Diabetic Retinopathy
AU - Stewart, Stephen
AU - Lois, Noemi
N1 - Copyright 2018 Asia-Pacific Academy of Ophthalmology.
PY - 2018/7/30
Y1 - 2018/7/30
N2 - Fenofibrate is a safe and inexpensive orally administered fibric acid derivative conventionally used to treat dyslipidemia. Two large randomized clinical trials, the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) studies, demonstrated the benefit of oral fenofibrate in the treatment of people with type 2 diabetes and diabetic retinopathy (DR), including reduced disease progression and need for laser treatment for diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). These findings are supported by results of experimental studies, which have demonstrated beneficial effects of fenofibrate ameliorating retinal vascular leakage and leukostasis, downregulating vascular endothelial growth factor (VEGF), and reducing endothelial cell and pericyte loss, among others-all characteristic features of DR. Fenofibrate is not prescribed routinely for the treatment of patients with diabetes and DR, despite this evidence. In FIELD and ACCORD, retinopathy was not the primary outcome and this may explain, at least partly, its lack of use for this indication. New trials are now underway to specifically address the effects of fenofibrate in DR; these trials will provide additional and robust data that may support current evidence favoring the use of fenofibrate in this common microvascular complication of diabetes.
AB - Fenofibrate is a safe and inexpensive orally administered fibric acid derivative conventionally used to treat dyslipidemia. Two large randomized clinical trials, the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) studies, demonstrated the benefit of oral fenofibrate in the treatment of people with type 2 diabetes and diabetic retinopathy (DR), including reduced disease progression and need for laser treatment for diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). These findings are supported by results of experimental studies, which have demonstrated beneficial effects of fenofibrate ameliorating retinal vascular leakage and leukostasis, downregulating vascular endothelial growth factor (VEGF), and reducing endothelial cell and pericyte loss, among others-all characteristic features of DR. Fenofibrate is not prescribed routinely for the treatment of patients with diabetes and DR, despite this evidence. In FIELD and ACCORD, retinopathy was not the primary outcome and this may explain, at least partly, its lack of use for this indication. New trials are now underway to specifically address the effects of fenofibrate in DR; these trials will provide additional and robust data that may support current evidence favoring the use of fenofibrate in this common microvascular complication of diabetes.
U2 - 10.22608/APO.2018288
DO - 10.22608/APO.2018288
M3 - Article
C2 - 30058790
SN - 2162-0989
JO - Asia-Pacific Journal of Ophthalmology
JF - Asia-Pacific Journal of Ophthalmology
ER -