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Updated: Jul 26, 2025

An Ex Vivo Tissue Culture Model for Fibrovascular Complications in Proliferative Diabetic Retinopathy
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Fenofibrate for diabetic retinopathy.

Sachiko Y Kataoka1, Noemi Lois2, Sumihiro Kawano3

  • 1Department of Health informatics, Kyoto University School of Public Health, Kyoto, Japan.

The Cochrane Database of Systematic Reviews
|June 13, 2023
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Fenofibrate likely makes little difference in diabetic retinopathy (DR) progression for most people with type 2 diabetes. However, it may slow DR progression in those with existing overt retinopathy, but increases risks of serious adverse events.

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Area of Science:

  • Ophthalmology
  • Endocrinology
  • Pharmacology

Background:

  • Diabetic retinopathy (DR) is a leading cause of blindness globally, imposing significant physical, psychological, and economic burdens.
  • Despite advances in diabetes management and new therapies, preventing DR progression and sight-threatening complications remains critical.
  • Fenofibrate is being investigated for its potential to mitigate DR by addressing underlying metabolic and inflammatory pathways.

Approach:

  • This study systematically reviewed randomized controlled trials (RCTs) comparing fenofibrate with placebo or observation in individuals with type 1 (T1D) or type 2 diabetes (T2D).
  • Searches were conducted across major databases including CENTRAL, MEDLINE, and Embase up to February 2022.
  • Primary outcome was DR progression, defined by incidence of overt retinopathy or advancement of DR severity; secondary outcomes included visual acuity, macular edema, and adverse events.

Key Points:

  • In people with type 2 diabetes (T2D), fenofibrate showed little to no difference in overall DR progression (moderate certainty evidence).
  • However, fenofibrate likely reduced DR progression in participants with pre-existing overt retinopathy (moderate certainty evidence).
  • Fenofibrate use was associated with an increased risk of serious adverse events (high certainty evidence).

Conclusions:

  • Current evidence suggests fenofibrate has a limited effect on overall DR progression in T2D but may benefit those with overt retinopathy.
  • The increased risk of serious adverse events necessitates careful consideration of fenofibrate's use.
  • Further research is needed, particularly in T1D populations, focusing on patient-important outcomes and comparative effectiveness with other DR treatments.