Switching from Conventional Fibrates to Pemafibrate Improves Lipid Profiles, Liver Enzymes, Renal Function, and Fibrosis Markers in Dyslipidemic Patients with MASLD: A Multicenter Real-World Study

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AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent worldwide. Conventional fibrates effectively lower triglycerides but may elevate liver enzymes and creatinine, limiting long-term use. Pemafibrate, a selective PPARα modulator (SPPARMα), offers potent triglyceride reduction with favorable hepatic and renal safety. This study evaluated the effects of switching from conventional fibrates to pemafibrate on lipid profiles, liver enzyme, fibrosis indices(Fibrosis-4 index) with particular emphasis on renal safety in clinical practice. METHODS: We retrospectively analyzed 144 patients with dyslipidemia, including those with MASLD or chronic kidney disease, who were switched from bezafibrate 200mg (N = 24) or 400mg (N = 30), or fenofibrate 80mg (N = 51) or 160mg (N = 39), to pemafibrate (0.2mg/day). Laboratory parameters were assessed at baseline and 6 months post-switch. RESULTS: Triglycerides decreased significantly, particularly in the bezafibrate 200 mg and fenofibrate 80 mg groups, while other lipid profiles remained stable. Serum alanine aminotransferase decreased significantly with bezafibrate 200mg (29±27 to 17±13U/L, p＜0.05) and fenofibrate 80mg (26±18 to 20±10 U/L, p＜0.05), whereas treatment with bezafibrate (400mg) and fenofibrate (160mg) showed a trend toward reduction. The glutamyl transferase showed a similar trend. The Fibrosis-4 index showed reductions across all groups, reaching statistical significance in bezafibrate200mg (1.51±0.63→1.36±0.47, p = 0.02) and fenofibrate 80mg (1.17±0.37→1.07±0.33, p = 0.001). Renal function remained stable across all groups, with no clinically significant deterioration in estimated glomerular filtration rate, supporting the renal safety of pemafibrate. CONCLUSION: Switching from conventional fibrates to pemafibrate improved triglyceride levels, liver enzymes, and fibrosis indices in patients with MASLD, while maintaining a favorable renal safety profile.

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