Effect of fenofibrate on the need for laser treatment for diabetic retinopathy (FIELD study): a randomised controlled trial

Fenofibric acid prevents retinal pigment epithelium disruption induced by interleukin-1β by suppressing AMP-activated protein kinase (AMPK) activation

“…It has recently been shown that fenofibrate, a PPAR-α agonist indicated for the treatment of hypertriacylglycerolaemia and mixed dyslipidaemia, reduces the progression of existing DR, thus lessening the need for laser treatment in both DMO and PDR [5]. This beneficial effect is unrelated to quantitative changes in serum lipids but other potential mechanisms, including its potential effect on the BRB, have recently been proposed [8].…”

“…Vascular leakage caused by the breakdown of the blood-retinal barrier (BRB) is the main event involved in the pathogenesis of DMO [3,4]. In the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study on DR, treatment with fenofibrate (a peroxisome proliferatoractivated receptor [PPAR]-α agonist) reduced the need for laser treatment for DMO and PDR by 30% [5]. In addition, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study has recently shown 40% reduction in the odds of having progression of DR in the group of patients receiving fenofibrate plus simvastatin compared with those patients treated with placebo plus simvastatin [6].…”

Standards of care for type 2 diabetes in China

“…Laser photocoagulation therapy may reduce high‐risk proliferative diabetic retinopathy, clinically significant macular oedema and the risk of blindness in some patients with severe non‐proliferative diabetic retinopathy 83.…”

Diabetic retinopathy: A comprehensive review

“…[53,54] The impact of long-term lipid lowering therapy on progression of retinopathy and the need for laser treatment in patients with type 2 diabetes has been assessed in the FIELD (FenoÞ brate Intervention and Event Lowering in Diabetes) study. [55] FIELD was a randomized, multinational placebo controlled study (n = 9795, aged 50-75 years). The results showed that in the fenoÞ brate group (n = 4895) the need for Þ rst laser treatment for retinopathy was signiÞ cantly (P = 0.0002) lower than in the placebo group (n = 4900) [3.4% versus 4.9%].…”

“…This study showed the beneÞ cial effects of fenoÞ brate in reducing the need for laser treatment for DR, independent of plasma lipid levels. [55] The mechanism behind this novel property of fenoÞ brate may be the result of its antiapoptotic activity in retinal endothelial cells, independent of its lipid lowering activity. [56] …”