Fenofibrate reduces laser photocoagulation (FIELD)

Does fenofibrate reduce the need for laser photocoagulation in patients with type 2 diabetes?

In patients with type 2 diabetes mellitus fenofibrate (Antara, Lofibra, Tricor) modestly reduces the number of laser treatments for retinopathy. (LOE = 1b)

Keech AC, Mitchell P, Summanen PA, et al, for the FIELD study investigators. Effect of fenofibrate on the need for laser treatment for diabetic retinopathy (FIELD study): a randomised controlled trial. Lancet 2007;370(9600):1687-1697.  [PMID:17988728]

Randomized controlled trial (double-blinded)

Industry + govt

Concealed

Outpatient (any)

The focus of this report is on the effect of fenofibrate on laser photocoagulation. The patients, between the ages of 50 years and 75 years with type 2 diabetes mellitus, were randomly assigned to receive 200 mg micronized fenofibrate every day or a matching placebo. The patients all had a total cholesterol level between 3.0 mmol/L and 6.5 mmol/L (115 and 250 mg/dL), plus either a total cholesterol/high density lipoprotein ratio of 4.0 or higher, or a triglyceride level between 1.0 mmol/L and 5.0 mmol/L (88 and 440 mg/dL). The use of laser treatment was adjudicated by at least 2 ophthalmologists masked to treatment allocation and were analyzed by intention to treat. At baseline, the 2 groups were similar in self-reported history of retinopathy. After approximately 5 years of follow up, 3.4% of patients receiving fenofibrate experienced their first laser treatment compared with 4.9% of the patients taking placebo (number needed to treat [NNT] for 5 years = 67; 95% CI, 44 - 139). Among patients with retinopathy at baseline, the NNT is 17.