Cholesterol-Lowering Drug Reduces Diabetic Eye Disease by Nearly 30 Percent: Oxford Study

The researchers also found that fenofibrate reduced patients’ likelihood of needing retinopathy treatment and their risk of developing macular edema.

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Commonly used cholesterol drug fenofibrate may help prevent eye disease in diabetes patients, according to a new Oxford study.

Researchers found that diabetic patients with retinopathy or maculopathy saw their disease progression reduced by 27 percent when they took fenofibrate for four years.

Compared to those who took a placebo, people who used the drug saw the absolute risk of needing further clinical referral reduced by 6.5 percentage points.

While fenofibrate is ordinarily used to lower cholesterol, it can also reduce inflammation and have vascular-protective effects. Both features may improve eye disease in diabetic patients.

The findings come from the Lowering Events in Non-Proliferative Retinopathy in Scotland (LENS) trial. They were presented at the American Diabetes Association’s (ADA) 84^th Scientific Sessions in Orlando, Florida, and published simultaneously in the New England Journal of Medicine Evidence on June 21.

“Diabetic retinopathy remains a leading cause of visual loss and we need simple strategies that can be widely used to reduce the progression of diabetic eye disease,” David Preiss, an associate professor at Oxford Population Health, said in a news release. “Results from the LENS trial suggest that fenofibrate may provide a valuable addition to treat people with diabetic retinopathy.”

Diabetic retinopathy occurs when high blood sugar levels damage small blood vessels in the retina, a layer of light-sensitive tissue at the back of the eyeball. It converts light into electrical signals that the brain interprets as images.

If left untreated for years, the disease can cause reduced visual acuity and blindness. Other symptoms include bleeding, retina detachment, and new eye cancers.

In addition to reducing the progression of the eye disease, the authors found that fenofibrate reduced patients’ likelihood of needing retinopathy treatment and their risk of developing macular edema. This condition occurs when fluid builds up in the central part of the retina, causing blurry vision.

“Treatment with fenofibrate appeared similarly effective in participants with type 1 and type 2 diabetes,” they wrote.

27 Percent Reduction in Disease Progression

The trial was conducted within Scotland’s Diabetic Eye Screening program and included 1,151 adults with early diabetic retinopathy or maculopathy, a disease affecting the eye’s macula. Any patient with diabetes could participate, but Type 1 diabetes patients comprised 26 percent of the enrollees. The average age of participants was 61, and 73 percent were men.

Study participants took either 145 milligrams of fenofibrate tablets or a placebo for four years.

The research team found that fenofibrate reduced the progression of the disease by 27 percent.

The authors gave several reasons as to why fenofibrate may benefit the eyes.

Fenofibrate stimulates the metabolism and breakdown of lipids in the body. This activity has been linked to anti-inflammatory and protective effects on the blood vessels, which may benefit retinal vasculature.

Animal studies have shown that fenofibrate reduces retinal leakage and inflammation. Its active form may also protect the blood–retina barrier. However, human studies have not solidly established fenofibrate’s effects on lowering blood sugar levels and cardiovascular risks.

The authors recommend that health care providers work with their diabetic patients and ophthalmologists to create a comprehensive care team to avoid progressive eye diseases associated with diabetes. The team noted that “population-based diabetic retinal screening is recommended to identify people at risk of vision-threatening disease and may also facilitate earlier intervention in those with non-vision-threatening disease.”

Drug Safety

Fenofibrate does come with side effects, although rates of serious adverse events were similar between the fenofibrate and placebo groups. Among people taking the drug, 36.1 percent experienced adverse events, while 35.5 percent of the placebo group did.

Fenofibrate is known to reversibly increase blood creatinine levels, a type of protein. Creatinine can cause fluid retention, fatigue, nausea, muscle cramps, chest pain, and itching, and high levels of creatinine can be a sign of kidney or liver problems.

Thirty-five patients who took fenofibrate died, compared to 38 participants who took the placebo. Fenofibrate patients also had lower levels of triglycerides than those taking the placebo due to the drug’s cholesterol-lowering effects.