Objective To systematically review the effects of fenofibrate on kidney function in various populations, so as to provide references for selecting the methods of treating hyperuricemia. Methods Such databases as PubMed (1966-2013), EMbase (1984-2013), The Cochrane Library (Issue 1, 2012), CBM (1978-2013), and CNKI (1989-2013) were electronically searched for relevant randomized controlled trials or non-randomized controlled trials on fenofibrate for treating hyperuricemia. According to the Cochrane methods, two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.0 software. Results A total of 16 studies involving 346 patients were included in total. The results of meta-analysis showed that: a) compared with the control group, the fenofibrate group had the lower serum uric acid level (WMD=48.68, 95%CI 10.02 to 87.34, Plt;0.000 01), lower Ccr (endogenous creatinine clearance) level (WMD=8.88, 95%CI 1.29 to 16.47, P=0.002), and similar serum creatinine level (WMD=1.78, 95%CI –2.86 to 6.42, P=0.45); and b) adverse reaction included gastrointestinal discomforts, skin rashes and transient increase of GPT and transaminase, most of which were mild. Conclusion Fenofibrate has good effects. Due to the low quality of the included studies, the exact effectiveness and adverse reaction need to be rigorously verified based on more multi-center, double-blind, randomized controlled trials with large sample size.
Objective To assess the effectiveness and safety of nine lipid-lowing agents in the national essential drug list (2000) and provide evidence for the adjustment and selection of essential drugs. Methods Based on principles of health technology assessment (HTA) and evidence-based medicine, we searched for all published clinical studies about these drugs from the following databases: MEDLINE (1966-2002.8), The Cochrane Library, EMBASE (1974-2002), CBMdisk (1979-2002.8) and VIP (1989-2002.8), the database of National Center for Adverse Drug Reaction(ADR) Monitoring of China and the database of WHO Uppsala drug monitoring center. Included studies were appraised, analyzed and compared for the reduction of triglyceride (TC) or low density lipoprotein (LDL-C), the prevention for the coronary events and the incidence of ADR. Results The results from comparative trials for lipid-lowing agents showed that the equivalent dose of statins for 25% reduction of LDL-C was atorvastatin 10 mg/d, simvastatin 20 mg/d, pravastatin 40mg/d, lovastatin 40 mg/d, cerivastatin 0.3 mg/d and fluvastatin 80 mg/d. It was difficult to compare fenofibrate with gemfibrozil, acipimox with statins or fibrates based on available data. The study on the primary and secondary prevention of cardiovascular events showed that pravastatin and lovastatin were effective in primary prevention, and long-term use could reduce the incidence of cardiovascular disease.Gemfibrozil could reduce the mortality from coronary heart disease (CHD) but the overall mortality was not changed. Pravastatin, simvastatin, atorvastatin, fluvastatin, gemfibrozil and fenofibrate had a confirmed effect in secondary prevention. Data from large-scale clinical trials and the reports from ADR monitoring center of England, America, Canada and Australia suggested that the statins which had rare ADR were safe and tolerated. Rhabdomyolysis was rare but had a serious adverse reaction associated with statins. The rate of fatal rhabdomyolysis related to cerivastatin was the highest among 6 statins. The safety of simvastatin, lovastatin and atorvastatin was lower than cerivastatin but higher than simvastatin and atorvastatin. The number of ADR reports of fenofibrate was fewer than that of gemfibrozil. Conclusions At present, the best evidence focused on pravastatin, simvastatin and lovastatin are widely used and have a confirmed safety and efficacy. Atorvastatin, fluvastatin and fenofibrate still need more data to confirm their effects on coronary heart disease prevention. The drugs which were shown to be inferior or insufficient evidence are cerivastatin, gemfibrozil and acipimox.
Chronic inflammation, oxidative stress and retinal ganglion cell apoptosis play important roles in the development of diabetic retinopathy. Fenofibrate, a peroxisome proliferator-activated receptor α agonist, is used for dyslipidemia. In addition to its lipid-modulating effects, fenofibrate also has anti-inflammatory, antioxidant, anti-apoptotic and anti-angiogenesis properties that may be useful to delay the progression of diabetic retinopathy. Some clinical studies have already confirmed that fenofibrate has therapeutic effect on diabetic retinopathy. Further studies the application of fenofibrate in the treatment of diabetic microangiopathy to clarify the safety and efficacy of fenofibrate is of great significance.