BY JOSEPH GUSTAITIS | JUNE 10, 2022
A while back we reported on how a medication (brand name Trulicity) created to treat one illness (diabetes) had been shown to be effective in treating another (heart disease). Now, according to research just published in the medical journal JAMA Ophthalmology, we now have another instance of a medication meant for one health problem being effective in treating another. In this case the medication is fenofibrate.
Originally formulated as a medication to lower lipids (blood fats like cholesterol), fenofibrate may be valuable for treating diabetic retinopathy, or eye disease, according to the research. Some earlier studies had suggested as much, but the evidence was inconclusive and ophthalmological societies had not made any recommendations, although fenofibrate has been approved for treating retinopathy in Australia. The investigative team behind the new study, which was led by Brian L. VanderBeek, MD, of the Scheie Eye Institute at the University of Pennsylvania in Philadelphia, sought to discover more consistent information by using a much larger study population.
The researchers drew their data from an initiative known as the Optum Clinformatics Data Mart Database, which is an administrative medical and pharmacy claims database with over 51 million commercial enrollees from a large national insurer made available by the University of Rhode Island College of Pharmacy. From this database they identified 150,252 people who had diabetic retinopathy. Of this group, 5,835 were taking fenofibrate to control their cholesterol levels and 144,417 were not. The research team adjusted for many possibly complicating factors, such as age, sex, race, education, income, geographic location, high blood pressure, use of statins (a class of cholesterol-lowering medicine) and insulin, heart disease, anemia, stroke, high cholesterol, and so on. The researchers were especially interested in how fenofibrate might affect two kinds of retinopathy. The first was proliferative diabetic retinopathy (PDR), a condition in which new blood vessels form on the surface of the retina (vision loss can result if these delicate vessels leak or rupture). The other type was vision-threatening diabetic retinopathy (VTDR). In VTDR, proliferative diabetic retinopathy is combined with diabetic macular edema (DME), a dangerous complication in which blood and fluids leak into the retina.
Fenofibrate linked to reduced risk of retinopathy progression
Comparing the patients who were using fenofibrate to those who were not, the researchers calculated the hazard ratio (HR) of progression to more severe stages of diabetic retinopathy. Compared with those not taking fenofibrate, those taking the drug had an 8% reduced risk of VTDR. As for PDR, the fenofibrate users had a 24% lower risk. Although the findings substantiated the results of the earlier, smaller studies, the researchers were unable to explain the mechanism through which fenofibrate appears to have this protective effect. Nevertheless, they concluded by stating, “These findings support the rationale for additional clinical trials to determine if these associations may be representative of a causal relationship between fenofibrate use and reduced risk of PDR or VTDR.”
The article in JAMA Ophthalmology was accompanied by an editorial written by Robert N. Frank, MD, of the Kresge Eye Institute of Wayne State University. He noted that the new study benefited from being based on a much larger data sample than earlier ones, “which makes these results especially noteworthy.” He further commented, “From the point of view of a clinician with a long-time interest in diabetic retinopathy, its causal mechanisms, and its evolving treatments, the possibility that an oral medication originally used for a different disease may be beneficial for the management of diabetic eye disease is exciting.”
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