July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Fenofibrate and Statin Use and the Risk of Progression to Vision Threatening Diabetic Retinopathy
Author Affiliations & Notes
  • Brian L VanderBeek
    Retina, Scheie Eye Institute University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • J. Clay Bavinger
    Retina, Scheie Eye Institute University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Yinxi Yu
    Retina, Scheie Eye Institute University of Pennsylvania, Philadelphia, Pennsylvania, United States
    Ophthalmology, Center for Preventive Ophthalmology and Biostatistics, Philadelphia, Pennsylvania, United States
  • Footnotes
    Commercial Relationships   Brian VanderBeek, None; J. Bavinger, None; Yinxi Yu, None
  • Footnotes
    Support  NEI grants 1K23EY025729-01 and 2P30EY001583
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 1083. doi:
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    • Get Citation

      Brian L VanderBeek, J. Clay Bavinger, Yinxi Yu; Fenofibrate and Statin Use and the Risk of Progression to Vision Threatening Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1083.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To assess the effect of fenofibrate and statin use on the progression from non-proliferative diabetic retinopathy (NPDR) to vision-threatening diabetic retinopathy (VTDR), proliferative diabetic retinopathy (PDR), or diabetic macular edema (DME).

Methods : This is a retrospective cohort study using medical claims data from a large U.S. insurer. Cohorts were created from all NPDR patients 18 years or older who had lab values from 2002-2016. Exclusion criteria consisted of any previous diagnosis of PDR, DME, proliferative vitreoretinopathy or treatment used in the care of VTDR. Patients were also excluded if they had a diagnosis of VTDR within 2 years of insurance plan entry, regardless of when NPDR was first noted in the plan. Days of fenofibrate and statin use were determined in a time-updating manner based on date of prescription fill and days of medication supplied. The main outcomes were a new diagnosis of VTDR (defined as either PDR or DME), DME or PDR individually. A time updating model for all covariates was used in multivariate Cox proportional hazard regression to determine hazards of progressing to an outcome. Additional covariates included systemic illnesses, demographics, kidney function (based on eGFR level), hemoglobin A1c, hemoglobin and erythropoietin stimulating agents or insulin use.

Results : 69,982 NPDR patients were included for analysis, of which 5,047 ever received a prescription for fenofibrates during their time in the plan of which 899, 127 and 754 progressed to VTDR, PDR and DME respectively. 45,769 ever received a prescription for a statin, of which 8,209, 1,387 and 6,652 progressed to VTDR, PDR and DME respectively. After controlling for all covariates, Cox model results showed fenofibrates to be associated with a protective effect for VTDR(HR:0.89,95%CI:0.82-0.98,p=0.01) and PDR(HR:0.71,95%CI:0.56-0.91,p=0.006), but not DME(HR:0.96,95%CI:0.87-1.06,p=0.39). Statin use was not associated with progression to VTDR(HR=0.98,95%CI:0.94-1.02,p=0.26) or DME(HR=1.01,95%CI:0.97-1.06,p=0.48), but was associated with an increased hazard for PDR(HR=1.12,95%CI:1.02-1.23,p=0.01).

Conclusions : Use of fenofibrates was protective for PDR, but not DME. Statin use was not associated with DME, but showed an increased risk for PDR.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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