Effect of fenofibrate on diabetic retinopathy progression: an RCT-Only systematic review and meta-analysis incorporating the LENS trial
Authors' conclusion
In adults with diabetes, predominantly type 2, fenofibrate slows structural DR progression but is not established as vision-preserving.
Study context
- Population
- Adults with diabetes, predominantly T2D (one trial 26% T1D), in randomised trials of fenofibrate reporting an ophthalmic outcome
- Participants
- 3,756 adults3 trials
- Comparison
- Fenofibrate vs control
- Outcome
- DR progression
Methodological detailspre-registered PRISMA 2020 protocol, random-effects, RoB 2, GRADE, Four databases searched to June 25, 2026; 10 studies included (6 completed with extractable results, 4 ongoing)
- Pre-registered PRISMA 2020 protocol
- Random-effects
- RoB 2
- GRADE
- Four databases searched to June 25, 2026; 10 studies included (6 completed with extractable results, 4 ongoing)
Pooled result
As reported in the abstract
Pooled RR for diabetic retinopathy (DR) progression (3 trials, N = 3,756)
RR 0.77
95% CI 0.68–0.88
HKSJ interval
0.60-0.99
Heterogeneity
I2 0%
Absolute effect
45 fewer events per 1,000
Further pooled results
DR progression, LENS composite definition
- Stratified RR
- 0.80 (0.68-0.93)
- Difference between strata P = 0.37
DR progression, ETDRS step-based definitions
- Stratified RR
- 0.70 (0.55-0.90)
- Difference between strata P = 0.37
Need for retinal treatment
- RR, conventional model
- RR 0.68, 0.57-0.82
- HKSJ interval crossed the null
- 0.42-1.11
- Weight from one pre-anti-VEGF-era trial
- 90.2%
- Low certainty
- Not firm evidence about contemporary treatment need
Visual acuity or function
- No trial found benefit for visual acuity or function
- Low certainty
Macular edema
- Macular edema evidence was not combinable
- Very low certainty
Safety
- VTE increased
- RR 1.52, 1.12-2.06
- Events (FIELD only)
- 103/4,755 vs 68/4,767
- Estimate derived entirely from FIELD
Original publication
Effect of fenofibrate on diabetic retinopathy progression: an RCT-Only systematic review and meta-analysis incorporating the LENS trial. Diabetes Res Clin Pract. Published 4 September 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →