Efficacy of Pemafibrate in Comparison to Fenofibrate and Bezafibrate on Triglyceride Levels and Liver, and Renal Functions in Patients With Hypertriglyceridemia and Type 2 Diabetes

Background: To compare the efficacy and safety of pemafibrate with those of fenofibrate in a real-world setting in patients with hypertriglyceridemia and type 2 diabetes (T2D). Methods: This study included 155 patients with hypertriglyceridemia (>175 mg/dL) and T2D. Adjusted least square mean changes in the serum levels of triglycerides (TG), transaminases, γ-glutamyl transpeptidase (γGTP), and estimated glomerular filtration rates (eGFRs) were compared before and after a 3-month therapy with pemafibrate (0.2 mg), fenofibrate (160 mg), or bezafibrate (400 mg). Multivariate logistic regression analyses were performed to examine the association between fibrates, achievement of target TG levels, and deterioration of liver and renal function. Results: Pemafibrate therapy greatly reduced TG levels, which was three times better than fenofibrate therapy in achieving the target range for TG levels. The administration of pemafibrate, not fenofibrate, was significantly associated with a lower risk of increasing γGTP levels. Similarly, a lower risk of eGFR reduction was observed in the pemafibrate group than in the fenofibrate group. Conclusions: Pemafibrate achieved a greater reduction in TG levels toward the desired target range than did fenofibrate. Moreover, pemafibrate was associated with a lower risk profile for elevated γGTP and reduced eGFR than fenofibrate.