Dissanayake Harsha A, Kiire Christine A, Preiss David, Tan Garry D
Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford University Hospitals, Oxford, UK; Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka.
Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
J Diabetes Complications. 2025 Oct;39(10):109135. doi: 10.1016/j.jdiacomp.2025.109135. Epub 2025 Jul 10.
Diabetic retinopathy (DR) is a leading cause of blindness despite advances in treatment and there remains an unmet need for low-cost interventions to prevent and slow the progression of DR. Fenofibrate has shown promise as a useful adjunct in DR management and is licensed for use in the treatment of DR in a few countries. However, the data supporting the use of fenofibrate for the treatment of DR emerged from subsidiary analyses of the FIELD, ACCORD-LIPID and its sub-study ACCORD-EYE trials, which were primarily designed to evaluate cardiovascular outcomes. The recently concluded LENS trial, designed to evaluate the effect of fenofibrate on progression of DR, has shown clear evidence of benefit over medium-term follow-up (i.e., 4-5 years), and confirmed its safety in people with type 1 or type 2 diabetes. These benefits appear to be independent of fenofibrate's lipid lowering effects and are more likely to be mediated via its direct effects on the eye. In this narrative review on the use of fenofibrate in the treatment of DR, we summarise the possible mechanisms of action, existing evidence from randomised trials, and implications for clinical practice and research.
尽管治疗方面取得了进展，但糖尿病视网膜病变（DR）仍是导致失明的主要原因，对于预防和延缓DR进展的低成本干预措施仍存在未满足的需求。非诺贝特已显示出有望成为DR管理中的一种有用辅助药物，并且在一些国家已获许可用于治疗DR。然而，支持非诺贝特用于治疗DR的数据来自FIELD、ACCORD - LIPID及其子研究ACCORD - EYE试验的次要分析，这些试验主要旨在评估心血管结局。最近完成的LENS试验旨在评估非诺贝特对DR进展的影响，已显示在中期随访（即4 - 5年）中有明显的获益证据，并证实了其在1型或2型糖尿病患者中的安全性。这些益处似乎独立于非诺贝特的降脂作用，更可能是通过其对眼睛的直接作用介导的。在这篇关于非诺贝特用于治疗DR的叙述性综述中，我们总结了可能的作用机制、随机试验的现有证据以及对临床实践和研究的意义。
