Fenofibrate use and diabetic retinopathy progression in patients with type 2 diabetes: a propensity-matched cohort study

초록

Background and aims: To determine the association between fenofibrate use and diabetic retinopathy progression in patients with type 2 diabetes (T2D) and metabolic syndrome undergoing statin therapy in a real-world database. Materials and methods: In this propensity-matched cohort study, patients with T2D and metabolic syndrome (≥ 30 years) receiving statin therapy were matched 1:2 by propensity score into the statin plus fenofibrate group (n=23,692) and statin-only group (n=46,223). The primary outcome was a composite of diabetic retinopathy progression including vitreous hemorrhage, vitrectomy, laser photocoagulation, intravitreous injection therapy and retinal detachment. Results: For the primary outcome, the incidence rate per 1,000 person year was 14.25 in the statin-only group and 12.65 in the statin plus fenofibrate group. The risk of the primary outcome was significantly lower (hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.83 to 0.96; p=0.001) in the statin plus fenofibrate group than in the statin-only group. Patients with retinopathy at baseline showed marked benefits of fenofibrate treatment (HR, 0.86; 95% CI, 0.78 to 0.94; p=0.001). In addition, the statin plus fenofibrate group exhibited significantly lower risks of vitreous hemorrhage (HR, 0.87; 95% CI, 0.78 to 0.96; p=0.008), laser photocoagulation (HR, 0.89; 95% CI, 0.81 to 0.98, p=0.022) and intravitreous injection therapy (HR, 0.78; 95% CI, 0.66 to 0.92; p=0.003) than those in the statin-only group. There was no significant interaction between the different characteristics at baseline and the treatment effect. Conclusion: In this propensity-weighted cohort study, the addition of fenofibrate to statins was associated with significantly lower risk of diabetic retinopathy progression than statin therapy alone in patients with T2D and metabolic syndrome.