Increased fenofibrate use not warranted in diabetes
Data from the first trial of long-term fibrate treatment do not warrant a recommendation for increased fenofibrate use in patients with diabetes, authors of a commentary on the study argue.
The study, published early online on The Lancet website,
randomised 9,795 patients aged 50–75 years with type 2 diabetes
to receive either placebo or micronised fenofibrate 200mg daily.
Although fenofibrate did not reduce the risk of a composite of coronary
heart disease death and non-fatal myocardial infarction, it did reduce
the total number of cardiovascular events (relative risk 0.89; 95 per
cent confidence interval 0.80–0.99, P=0.035). This reduction was
principally the result of a 24 per cent reduction in non-fatal MI (0.76;
0.62–0.94, P=0.010).
However, the authors of an accompanying commentary (ibid) argue that
large differences in the results for different subgroups in the trial
mean that the study is unable to provide clear answers about the efficacy
and safety of fenofibrate. For instance, the 11 per cent reduction in
cardiovascular events was made up of a 25 per cent reduction for patients
without previous cardiovascular disease and a non-significant 8 per cent
increase for patients with previous cardiovascular disease.
“
The results from this well executed trial do not warrant a recommendation
for increased fenofibrate use in patients with diabetes, nor do they
provide convincing evidence of the benefit of fenofibrate therapy in
patients already at target serum low-
density lipoprotein cholesterol,” the commentators say. |
The
Pharmaceutical Journal
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