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The lipid lowering agent fenofibrate could be useful for treating diabetic retinopathy if findings from a recent clinical trial are confirmed. Nearly 10000 patients with type 2 diabetes took fenofibrate or a placebo for five years in addition to their usual antidiabetic and cardiovascular drugs. Fenofibrate reduced the need for laser treatment of retinopathy by almost a third (3.4% v 4.9%, hazard ratio 0.69, 95% CI 0.56 to 0.84) and seemed to slow progression of disease in some patientspatients.
These findings are a small slice of a large trial looking at all microvascular and macrovascular complications of diabetes so the results are still preliminary, says an editorial (doi: 10.1016/S0140-6736(07)61608-0). Most participants didn't have retinal photographs at the start of the trial because laser treatment for retinopathy was not the researcher's main focus. We still don't know for certain whether fenofibrate works best for patients with or without pre-existing retinopathy. In the 1012 patients who did have serial photographs, fenofibrate slowed the progression of existing retinopathy only—it did not help to preserve sight.
We also need to know more about how it works. In this trial, the effects of fenofibrate on retinopathy were entirely separate from its expected effects on serum lipids.