Fenofibrate Markedly Lowers Progression of Diabetic Retinopathy

David Preiss, MBChB, PhD

Credit: University of Oxford

Fenofibrate, a common cholesterol-lowering drug, significantly reduced the progression of vision loss in patients with diabetic retinopathy (DR), according to new data presented at the American Diabetes Association (ADA) 84th Scientific Sessions.¹

The LENS trial was conducted within Scotland’s Diabetic Eye Screening (DES) program, involving more than 1,000 adults with early diabetic retinopathy or maculopathy, assigned to treatment with either fenofibrate tablets or placebo.

“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 diseases,” said David Preiss, MBChB, PhD, an associate professor at Oxford Population Health.²

Diabetic retinopathy is the most frequent complication of diabetes and is the leading cause of blindness in the working-age population.³ Its prevalence has increased globally over the past three decades and marks a significant public health concern.

High glucose levels can damage blood vessels in the retina and lead to vision problems or even blindness. Effective management of blood glucose levels becomes critical to reduce the risk of disease progression. However, there are barriers to achievement in many patients with DR and few specific treatment options for patients with early retinopathy.

Investigators in the LENS trial aimed to evaluate the impact of a well-understood solution for high cholesterol, fenofibrate, on outcomes in patients with DR.¹

Scotland’s DES program provides regular retinal imaging to all patients with diabetes aged ≥12 years across the country. Using the DES program, the randomized controlled LENS trial included 1,151 adults with early diabetic retinopathy or maculopathy, assigned to receive either 145 mg fenofibrate tablets or placebo treatment.

The primary outcome was a composite measure of referable diabetic retinopathy or maculopathy, meaning a grading of diabetic eye disease warranted specialist ophthalmic review, or required laser treatment, intravitreal injection, or vitrectomy.

Results from the analysis showed fenofibrate may be an effective treatment option for patients with early diabetic retinopathy. Across the 4-year study period, fenofibrate was associated with a 27% reduction in the progression of DR in patients taking the drug, compared with placebo (22.7% vs. 29.2%). This difference was highly statistically significant (P = .006).

Other data revealed fenofibrate reduced the potential of any progression of retinopathy and lowered the risk of developing macular edema. This was the first large-scale trial specifically created to evaluate the effect of fenofibrate on eye outcomes in individuals with early diabetic retinopathy.

“Results from the LENS trial suggest that fenofibrate may provide a valuable addition to treat people with diabetic retinopathy,” Preiss added.²

The release also indicated the LENS investigator’s partnership with Scotland’s DES has allowed the collection of 9,000 retinal images, which will be analyzed through machine learning to comprehend the effect of fenofibrate in the diabetic eye.² Thus, participants will be followed across linkage to national health records to understand the long-term effects of fenofibrate on health outcomes.

References

1. _{Preiss D. The Effect of Fenofibrate on Progression of Diabetic Retinopathy—Results from the LENS Trial. Symposium presented at the American Diabetes Association (ADA) 84th Scientific Sessions. Orlando, Florida. June 21-24.}
2. _{American Diabetes Association. Common Cholesterol-Lowering Drug Found to Slow Vision Loss in Diabetes Patients. Published June 21, 2024. Accessed June 21, 2024.}
3. _{Kropp M, Golubnitschaja O, Mazurakova A, et al. Diabetic retinopathy as the leading cause of blindness and early predictor of cascading complications-risks and mitigation. EPMA J. 2023;14(1):21-42. Published 2023 Feb 13. doi:10.1007/s13167-023-00314-8}