Medical Tribune September 2008 P4
David Brill
Doctors should routinely
consider prescribing fenofibrate
alongside statins for
their diabetic patients, two leading
experts advised recently.
A large multinational trial,
published last year in The Lancet,
showed that fenofibrate significantly
reduced the chances of
needing laser treatment for retinopathy
among type 2 diabetics.
[370(9600):1687-97]
Yet awareness of the condition
and the protective effects of fenofibrate
is low according to Anthony
Keech, professor of medicine, cardiology
and epidemiology and
deputy director of the National
Health and Medical Research
Council Clinical Trials Centre at the
University of Sydney, Australia. He
was speaking at a press conference
recently held in Singapore.
“Doctors need to know that diabetic
eye disease is highly prevalent.
And secondly they need to be
aware of these findings – that one
can actually retard the progression
of the condition easily with a oncea-
day tablet,” he said.
The Fenofibrate Intervention
and Event Lowering in Diabetes
(FIELD) study randomized 9,795
patients at 63 sites to placebo or
fenofibrate (200 mg/day).
After an average of 5 years follow-
up, 238 patients (4.9 percent)
in the placebo group had undergone
laser surgery compared to
just 164 (3.4 percent) of those in the
fenofibrate group – corresponding
to a hazard ratio of 0.69 (P=0.0002).
The safety profile of the drug was
similar to that of placebo.
“These are really sensational
findings that caused a great deal
of excitement around the world,
particularly as this is something
that statins don’t seem to do,” said
Keech, who was principal investigator
for the FIELD study.
“I think that as people become
aware of these results … they will
form the view that really there’s
no reason why you wouldn’t want
everybody with diabetes to be on
this treatment. Certainly if I had
diabetes I’d be running to get it,”
he said.
Laser treatment is proven to be
a successful treatment for retinopathy
but can reduce the visual field
and cause other ocular side-effects.
Professor Wong Tien Yin, one of
Singapore’s top ophthalmologists,
called on primary care physicians
to do more to prevent the development
of diabetic retinopathy.
“This is a message that needs
to go out to GPs, polyclinics, cardiologists
and diabetologists – those
people that manage diabetes.
“When [patients] see me for laser
treatment it’s quite late already.
We want them to start sorting it out
early, and we want to avoid laser
treatment … you can’t wait until
you have problems before you
go and see an ophthalmologist,”
he said, adding that awareness of
fenofibrate among doctors in Singapore
is currently “not there.”
In general around a third of
diabetics will develop retinopathy
at some point said Wong, who is
an ophthalmology professor at the
National University of Singapore
and deputy director of the Singapore
Eye Research Institute.
A study of 3,000 Singaporean
diabetics carried out last year found
that 35 percent were affected, yet
80 percent of them had not seen an
eye doctor and were unaware that
they had the condition, he said.
As the prevalence of diabetes
continues to rise throughout Asia,
fenofibrate will become an important
addition to other interventions
in tackling the disease, he added.
Keech added that unlike some
other fibrates, fenofibrate is safe in
combination with statins, and that
he sees no downside to the treatment.
“I think that within a few years
time people will believe that every
patient with diabetes should be on
fenofibrate, or a similar treatment,
for its macro- and microvascular
benefits,” he concluded.
David Brill
Doctors should routinely
consider prescribing fenofibrate
alongside statins for
their diabetic patients, two leading
experts advised recently.
A large multinational trial,
published last year in The Lancet,
showed that fenofibrate significantly
reduced the chances of
needing laser treatment for retinopathy
among type 2 diabetics.
[370(9600):1687-97]
Yet awareness of the condition
and the protective effects of fenofibrate
is low according to Anthony
Keech, professor of medicine, cardiology
and epidemiology and
deputy director of the National
Health and Medical Research
Council Clinical Trials Centre at the
University of Sydney, Australia. He
was speaking at a press conference
recently held in Singapore.
“Doctors need to know that diabetic
eye disease is highly prevalent.
And secondly they need to be
aware of these findings – that one
can actually retard the progression
of the condition easily with a oncea-
day tablet,” he said.
The Fenofibrate Intervention
and Event Lowering in Diabetes
(FIELD) study randomized 9,795
patients at 63 sites to placebo or
fenofibrate (200 mg/day).
After an average of 5 years follow-
up, 238 patients (4.9 percent)
in the placebo group had undergone
laser surgery compared to
just 164 (3.4 percent) of those in the
fenofibrate group – corresponding
to a hazard ratio of 0.69 (P=0.0002).
The safety profile of the drug was
similar to that of placebo.
“These are really sensational
findings that caused a great deal
of excitement around the world,
particularly as this is something
that statins don’t seem to do,” said
Keech, who was principal investigator
for the FIELD study.
“I think that as people become
aware of these results … they will
form the view that really there’s
no reason why you wouldn’t want
everybody with diabetes to be on
this treatment. Certainly if I had
diabetes I’d be running to get it,”
he said.
Laser treatment is proven to be
a successful treatment for retinopathy
but can reduce the visual field
and cause other ocular side-effects.
Professor Wong Tien Yin, one of
Singapore’s top ophthalmologists,
called on primary care physicians
to do more to prevent the development
of diabetic retinopathy.
“This is a message that needs
to go out to GPs, polyclinics, cardiologists
and diabetologists – those
people that manage diabetes.
“When [patients] see me for laser
treatment it’s quite late already.
We want them to start sorting it out
early, and we want to avoid laser
treatment … you can’t wait until
you have problems before you
go and see an ophthalmologist,”
he said, adding that awareness of
fenofibrate among doctors in Singapore
is currently “not there.”
In general around a third of
diabetics will develop retinopathy
at some point said Wong, who is
an ophthalmology professor at the
National University of Singapore
and deputy director of the Singapore
Eye Research Institute.
A study of 3,000 Singaporean
diabetics carried out last year found
that 35 percent were affected, yet
80 percent of them had not seen an
eye doctor and were unaware that
they had the condition, he said.
As the prevalence of diabetes
continues to rise throughout Asia,
fenofibrate will become an important
addition to other interventions
in tackling the disease, he added.
Keech added that unlike some
other fibrates, fenofibrate is safe in
combination with statins, and that
he sees no downside to the treatment.
“I think that within a few years
time people will believe that every
patient with diabetes should be on
fenofibrate, or a similar treatment,
for its macro- and microvascular
benefits,” he concluded.
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