ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Clinical Diabetes
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1496671
This article is part of the Research TopicMetabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) - Pathogenesis, Prevention and TreatmentView all 13 articles
Treatment with pemafibrate ameliorates fatty liver index and atherogenic lipid profiles in Japanese patients with type 2 diabetes mellitus
Provisionally accepted
Toru Suzuki
Tatsuya Sato
Marenao TanakaKei NakataKeisuke EndoHiroki AidaWataru KawaharataItaru HosakaAraya UmetsuToshifumi OgawaYukinori Akiyama
Masato Furuhashi*- Sapporo Medical University, Sapporo, Japan
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Background: Pemafibrate, a selective peroxisome proliferator-activated receptor α modulator, ameliorates hypertriglyceridemia. We investigated the effects of pemafibrate on steatotic liver disease (SLD) in relation to various atherogenic lipid profiles.Methods: Thirty-nine Japanese patients with both type 2 diabetes mellitus (T2DM) and hypertriglyceridemia (men/women: 24/15, mean age: 58.2 years, median duration of diabetes: 5.0 years) were treated with 0.2 mg/day of pemafibrate for 12 months (M). SLD was estimated by fatty liver index (FLI), which is calculated by using waist circumference, body mass index and levels of triglycerides and γ-glutamyl transpeptidase. Results: Treatment with pemafibrate significantly increased mean levels of high-density lipoprotein cholesterol (HDL-C) (baseline/3M/6M/12M: 46/55/55/54 mg/dL) and decreased median levels of triglycerides (baseline/3M/6M/12M: 211/112/99/98 mg/dL), non-HDL-C (146/128/125/121 mg/dL), small dense low-density lipoprotein cholesterol (45/33/30/30 mg/dL) and remnant-like particle cholesterol (8.1/2.6/2.3/2.4 mg/dL). There was no significant change in hemoglobin A1c level over time. FLI (mean ± standard deviation: 68.1 ± 21.9 vs. 39.6 ± 25.0, P < 0.001), but not FIB-4 index as a marker of hepatic fibrosis (median [interquartile range]: 1.04 [0.78-1.39] vs. 1.01 [0.68-1.36], P = 0.909), was significantly decreased by treatment with pemafibrate for 12M, and the proportion of patients with metabolic dysfunction-associated SLD (MASLD) was significantly decreased from 92.3% (baseline) to 61.5% (12M). Conclusions: Pemafibrate ameliorates MASLD estimated by FLI in addition to various atherogenic lipid profiles in Japanese hypertriglyceridemia patients with T2DM in the past mean 5 years. An early intervention with pemafibrate might contribute to prevention of the development of MASLD and atherosclerotic cardiovascular disease.
Keywords: Pemafibrate, Fatty liver index, Metabolic dysfunction-associated steatotic liver disease, type 2 diabetes, atherogenic lipid profiles Variables are expressed as number (%), means ± SD or medians [interquartile ranges]. ALP, alkaline phosphatase, ALT, alanine transaminase, Apo, apolipoprotein, AST, aspartate transaminase
Received: 15 Sep 2024; Accepted: 17 Jun 2025.
Copyright: © 2025 Suzuki, Sato, Tanaka, Nakata, Endo, Aida, Kawaharata, Hosaka, Umetsu, Ogawa, Akiyama and Furuhashi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Masato Furuhashi, Sapporo Medical University, Sapporo, Japan
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