Fenofibrate therapy of hyperlipoproteinaemia. A dose-response study and a comparison with clofibrate.

Fenofibrate is an efficient serum lipid-lowering drug with few clinical side effects. The drug was further evaluated in a study comprising 56 patients, which combined a dose-response trial with a subsequent comparison between the optimal fenofibrate dose and a clofibrate dose of 2 g/day. When the fenofibrate dose was gradually increased (200-300-400 mg/day), a reduction of the elevated lipoproteins within each type of hyperlipoproteinaemia was found. During the dose-response part of the therapy a transient serum creatinine rise was observed, which disappeared at the 400 mg/day level. The highest dose, 400 mg/day, proved to have the best lipid-lower effects. On this therapy the elevated LDL-cholesterol fell by 28% in type IIA + B patients, and the elevated VLDL-TG by 65% in type IIB + IV patients. The HDL/VLDL + LDL-cholesterol ratio increased significantly in all groups, in particular in type IV patients (from 0.19 to 0.28, P less than 0.001). Fenofibrate and clofibrate were each given for 2 months in random order, and the effects on lipoproteins compared. Significant differences were: higher HDL-cholesterol in type IIA on clofibrate, lower LDL-cholesterol in type IIB on fenofibrate, lower TG and cholesterol in both VLDL an LDL in type IV on fenofibrate, combined with higher HDL-cholesterol on this drug. Thus, fenofibrate seems to be an efficient lipid lowering drug with 400 mg/day as an optimal dosage under our conditions.