Imamura Teruhiko, Narang Nikhil, Kinugawa Koichiro
The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan.
Advocate Christ Medical Center, Oak Lawn, IL 60453, USA.
J Clin Med. 2022 May 17;11(10):2820. doi: 10.3390/jcm11102820.
Background: Pemafibrate is a novel selective peroxisome proliferator-activated receptor-α modulator, which was demonstrated to reduce serum triglyceride level with few drug-related adverse events in phase II and III clinical trials. However, its clinical implication in real-world practice remains unknown. Triglyceride/HDL-cholesterol ratio is a surrogate of small dense LDL-cholesterol, which is a newly proposed cardiovascular risk factor independent of LDL-cholesterol levels. Methods: Consecutive patients who received pemafibrate between April 2020 and September 2021 and continued therapy for at least 3 months were included in this retrospective analysis. The primary outcome was the trend in triglyceride/HDL-cholesterol ratio during the 3-month treatment period. The change in cardiovascular event rate between the one-year pre-treatment period and the on-treatment period was also analyzed. Results: A total of 19 patients (median age 63 years, 74% men) were included and continued pemafibrate therapy for 3 months without any drug-related adverse events. Sixteen were add-on and three were conversions from other fibrates. Triglyceride/HDL-cholesterol ratio decreased significantly from 5.85 (4.19, 16.1) to 3.14 (2.39, 4.62) (p < 0.001). The cardiovascular event rate decreased significantly from 0.632 events/year to 0.080 events/year (p < 0.001). Conclusions: Pemafibrate therapy might have the potential to lower triglyceride/HDL-cholesterol ratio and decrease cardiovascular events.
佩马贝特是一种新型的选择性过氧化物酶体增殖物激活受体-α调节剂，在II期和III期临床试验中已证明其能降低血清甘油三酯水平，且药物相关不良事件较少。然而，其在实际临床实践中的意义仍不明确。甘油三酯/高密度脂蛋白胆固醇比值是小而密低密度脂蛋白胆固醇的替代指标，小而密低密度脂蛋白胆固醇是一种新提出的独立于低密度脂蛋白胆固醇水平的心血管危险因素。方法：本回顾性分析纳入了2020年4月至2021年9月期间接受佩马贝特治疗且持续治疗至少3个月的连续患者。主要结局是3个月治疗期内甘油三酯/高密度脂蛋白胆固醇比值的变化趋势。还分析了治疗前一年期与治疗期心血管事件发生率的变化。结果：共纳入19例患者（中位年龄63岁，74%为男性），持续接受佩马贝特治疗3个月，无任何药物相关不良事件。16例为加用治疗，3例由其他贝特类药物转换而来。甘油三酯/高密度脂蛋白胆固醇比值从5.85（4.19，16.1）显著降至3.14（2.39，4.62）（p<0.001）。心血管事件发生率从0.632次/年显著降至0.080次/年（p<0.001）。结论：佩马贝特治疗可能有降低甘油三酯/高密度脂蛋白胆固醇比值和减少心血管事件的潜力。
