The LENS trial, conducted by David Preiss, MBChB, PhD, revealed that fenofibrate has the potential to reduce the progression of early diabetic retinopathy and maculopathy among diabetes patients. Over a span of 4 years, the fibrate showed a relative 27% decrease in disease progression when compared to a placebo. This groundbreaking information was presented at the American Diabetes Association annual meeting and simultaneously published in the NEJM Evidence, shedding light on the efficacy of this affordable and generic drug in addressing a major cause of visual loss.
While the results of the LENS trial are promising, there are practical hurdles that need to be overcome in order to implement this treatment on a larger scale. Amanda Adler, MD, PhD, highlighted the importance of monitoring for creatinine elevation, which may be a requirement for patients using fenofibrate. Moreover, questions regarding the regulatory approval process for off-patent drugs like fenofibrate need to be addressed to ensure widespread access to this potentially sight-saving medication.
Alicia Jenkins, MBBS, MD, emphasized the need for collaborations and independent meta-analyses to further solidify the evidence supporting the use of fenofibrate in diabetes patients. By pooling data from multiple trials, researchers can gain a more comprehensive understanding of the drug’s impact on different types of diabetes and disease progression rates. These collaborative efforts will be instrumental in shaping guidelines for the use of fenofibrate in the management of diabetic retinopathy.
While fenofibrate is already approved for the treatment of retinopathy in type 2 diabetes patients in Australia and other countries, there is still work to be done in terms of educating healthcare providers about the benefits of this medication. Ophthalmologists may need additional training to feel comfortable prescribing systemic therapies like fenofibrate, which underscores the importance of consensus statements and guidelines to support their decision-making process.
The LENS trial enrolled 1,151 adults with nonreferrable diabetic retinopathy or maculopathy, randomizing them to receive either fenofibrate or a placebo. The primary outcome of the trial was a composite measure of disease progression that required specialist ophthalmic review or treatment intervention. Fenofibrate demonstrated a significant reduction in the frequency of retinopathy progression, development of macular edema, and overall need for treatment compared to the placebo group. While the trial did not show a significant impact on lipid levels, the researchers believe that fenofibrate’s effects may be localized within the eye, influencing vascular leakage and inflammation.
The findings from the LENS trial present a compelling argument for the use of fenofibrate in diabetes patients to prevent or delay the progression of retinopathy. By leveraging these results and fostering collaborations within the scientific community, we can pave the way for improved eye health outcomes for individuals living with diabetes. The potential cost savings and clinical benefits associated with fenofibrate make it a promising option for early intervention in diabetic retinopathy, highlighting the need for continued research and advocacy in this area.