Fenofibrate reduces laser photocoagulation (FIELD)

General

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

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

Reference:
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]

Study Design:
Randomized controlled trial (double-blinded)

Allocation:
Concealed

Setting:
Outpatient (any)

Synopsis:
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.

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Citation

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TY - ELEC T1 - Fenofibrate reduces laser photocoagulation (FIELD) ID - 426432 ED - Barry,Henry, ED - Ebell,Mark H, ED - Shaughnessy,Allen F, ED - Slawson,David C, BT - EE+ POEM Archive UR - https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426432/all/Fenofibrate_reduces_laser_photocoagulation__FIELD_ PB - John Wiley & Sons DB - Evidence Central DP - Unbound Medicine ER -