Association of fenofibrate use with progression of ocular disease in individuals with diabetes

Background/aims Fenofibrates may slow progression of diabetic retinopathy (DR). This study used the large international TriNetX database to evaluate progression of retinopathy and development of cataracts, primary open angle glaucoma (POAG) and diabetic macular oedema (DME) in patients with diabetes with and without fenofibrate use. Methods In this retrospective cohort study, ICD10 codes and RxNorm were used to identify patients in the TriNetX database aged ≥18 years with a diagnosis of diabetes mellitus (DM), with mild or moderate non-proliferative diabetic retinopathy (NPDR) and with and without fenofibrate use from December 2014 through December 2024. ORs were calculated to analyse the proportion of individuals with mild or moderate NPDR using fenofibrate who developed vision-threatening DR (VTDR, defined as severe NPDR or proliferative DR), cataracts, POAG or DME compared with those not taking fenofibrate. Those with cataracts, POAG or DME at baseline were excluded from their respective outcomes analyses. Results After propensity score matching, 4316, 4200, 4073 and 4571 individuals prescribed fenofibrate were compared with the same number who were not prescribed fenofibrate for progression to VTDR, cataract, POAG or DME, respectively. The ORs for DR progression (OR 0.528, 95% CI 0.333 to 0.838; p=0.0059), cataract (OR 0.585, 95% CI 0.441 to 0.774; p=0.0002) and DME (OR 0.316, 95% CI 0.243 to 0.411; p<0.0001) development were lower for individuals taking fenofibrate compared with those not taking fenofibrate. Conclusion Fenofibrate use is associated with significantly lower risk of developing VTDR, cataracts and DME in patients with mild or moderate NPDR.