Pemafibrate superior to conventional fibrates in T2DM

Treatment with pemafibrate in patients with type 2 diabetes mellitus (T2DM) yields more favourable effects on lipid profile, as well renal function, as compared with conventional fibrates, a study has found.

The multicentre prospective observational study included 650 patients with T2DM and hypertriglyceridemia, of which 504 were included in the analysis after propensity score matching; 252 patients used pemafibrate and 252 conventional therapy, with or without a fibrate.

Treatment with pemafibrate produced significant reductions in the primary outcome of fasting serum triglyceride and high-density lipoprotein-cholesterol (HDL-C) concentrations at week 52 (p<0.001 for both).

Of note, multiple indices reflecting triglyceride-rich lipoproteins, low-density lipoprotein-cholesterol particle size, and liver enzyme elevations significantly improved in the pemafibrate group than in the control group. However, there was no between-group difference seen in glycaemic control markers.

Furthermore, pemafibrate had superior effect on renal function. Specifically, switching from conventional fibrates to pemafibrate resulted in improved estimated glomerular filtration rate (eGFR) levels but increased uric acid concentration.

Pemafibrate is a novel selective peroxisome proliferator-activated receptor (PPARα) modulator that has been shown to have a stronger triglyceride-lowering effect than existing fibrate preparations and can be used in combination with statins. The drug selectively regulates target genes involved in lipid metabolism among these PPARα-regulated genes. [Lipids Health Dis 2021;20:17; J Clin Lipidol 2018;12:173-184; Am H J 2018;206:80-93; Cardiovasc Diabetol 2017;16:124]