Efficacy of pemafibrate on triglyceride levels, liver and renal functions compared with femafibrate and bezafibrate in patients with hypertriglyceridemia and type 2 diabetes

Abstract Purpose To evaluate and compare the efficacy and safety of pemafibrate, a selective peroxisome proliferator-activator α modulator, with fenofibrate and bezafibrate, classical fibrates, in a real-world setting in patients with hypertriglyceridemia and type 2 diabetes (T2D). Methods 200 patients with hypertriglyceridemia (> 175 mg/dL) and T2D were studied. Adjusted least square mean percentage changes in serum levels of triglyceride (TG), transaminases, γ-glutamyl transpeptidase (γGTP), and creatinine kinase (CK) levels, and estimated glomerular filtration rates (eGFRs) were compared before and after 3-month therapy with pemafibrate 0.1 mg and 0.2 mg, fenofibrate 160 mg, and bezafibrate 400 mg. Multivariate logistic regression analyses were performed to examine the association between the fibrate therapy and achievement of TG target levels (< 175 mg/dL) and the deterioration of liver and renal functions. Results The pemafibrate therapy exhibited a greater reduction in TG levels of 50%, which was 3–4 times better at achieving the target range for TGs, than fenofibrate. The administration of pemafibrate but not fenofibrate was significantly associated with a lower risk of elevation in γGTP. Similarly, a smaller risk of reduction in eGFR was observed in the pemafibrate groups than in the fenofibrate group. Conclusion Pemafibrate therapy achieved a greater reduction in TG levels towards the desired target range than fenofibrate therapy. Moreover, pemafibrate was associated with a lower risk profile for elevated γGTP and reduced eGFR than fenofibrate.