Effect of systemic fibrates on diabetic retinopathy prevention and progression: A comprehensive systematic review and meta-analysis
In brief
Fenofibrate cuts diabetic retinopathy progression odds by 44% in established disease
In five randomized trials of people with established diabetic retinopathy, fenofibrate reduced the odds of overall progression by 44% and progression to diabetic macular edema by 48%. By contrast, two trials found no clear benefit for preventing retinopathy from developing, and their estimate was too imprecise to rule out a modest benefit or harm.
- Journal
- Survey of ophthalmology (Q1)
- Published
- 23 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Luke Yaldo, Abdelaziz Abdelaal, Joshua Ong, Lauren Kiryakoza, Jesse Sengillo, Raquel Goldhardt
- PMID
- 42778039
- DOI
- 10.1016/j.survophthal.2026.09.006
Why clinicians should know about it
- Picked for Ophthalmology (paper of the day, 24 September 2026): Systematic review of fibrates for diabetic retinopathy progression
Abstract
Diabetic retinopathy is a leading cause of vision loss in adults with diabetes, and the role of systemic fibrate therapy in its prevention and progression remains debated. We performed a systematic review and meta-analysis to evaluate the effect of fibrates on diabetic retinopathy development and progression, distinguishing randomized from non-randomized evidence. We searched PubMed, Scopus, and Web of Science from inception to August, 2025, and included 31 studies (17 development, 15 progression). Trials enrolling mixed populations were extracted by baseline retinopathy status. Random-effects pooling of 2 randomized trials showed no evidence of a benefit of fenofibrate for incident diabetic retinopathy (odds ratio 1.00, 95% confidence interval 0.70-1.43; low certainty). This estimate is imprecise and cannot exclude a modest protective or harmful effect. Five randomized trials in patients with established disease showed reduced overall progression (odds ratio 0.56, 95% confidence interval 0.42-0.74; moderate certainty) and reduced progression to diabetic macular edema (odds ratio 0.52, 95% confidence interval 0.36-0.74; moderate certainty). Adjusted estimates from non-randomized studies were directionally consistent. These findings support a stage-specific role for fenofibrate in patients with established diabetic retinopathy, particularly to reduce progression to diabetic macular edema, while the evidence for primary prevention remains inconclusive.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.