Saroglitazar is noninferior to fenofibrate in reducing triglyceride levels in hypertriglyceridemic patients in a randomized clinical trial.

Saroglitazar, being a dual PPAR-α/γ agonist, has shown beneficial effect in diabetic dyslipidemia and hypertriglyceridemia. Fibrates are commonly used to treat severe hypertriglyceridemia. However, the effect of saroglitazar in patients with moderate to severe hypertriglyceridemia was not evaluated. We conducted a study to compare the efficacy and safety of saroglitazar (4 mg) with fenofibrate (160 mg) in patients with moderate to severe hypertriglyceridemia. This was a multicenter, randomized, double-blinded, double-dummy, active-control, and noninferiority trial in adult patients with fasting triglyceride (TG) levels of 500-1,500 mg/dl. The patients were randomized in a 1:1 ratio to receive daily dose of saroglitazar or fenofibrate for 12 weeks. The primary efficacy end point was the percent change in TG levels at week 12 relative to baseline. The study comprised of 41 patients in the saroglitazar group and 41 patients in the fenofibrate group. We found that the percent reduction from baseline in TG levels at week 12 was significantly higher in the saroglitazar group (least square mean = -55.3%; SE = 4.9) compared with the fenofibrate group (least square mean = -41.1%; SE = 4.9; P = 0.048). Overall, 37 treatment-emergent adverse events (AEs) were reported in 24 patients (saroglitazar: 13; fenofibrate: 11). No serious AEs were reported, and no patient discontinued the study because of AEs. We conclude that saroglitazar (4 mg) is noninferior to fenofibrate (160 mg) in reducing TG levels after 12 weeks of treatment, was safe, and well tolerated.

A Case of Fenofibrate-Induced Immune Thrombocytopenia: First Report.

Fenofibrate is widely prescribed as a hypolipidemic drug and is well tolerated by most patients. We present the case of a 40-year-old woman who developed severe immune thrombocytopenia while on fenofibrate treatment. Clinical features included spontaneous bruising on the feet and hands, a purpuric rash, and menorrhagia. All the laboratory results were normal except for the finding of isolated thrombocytopenia. The subsequent evolution was favorable after fenofibrate removal and with the administration of immunoglobulin G (IgG) plus corticosteroids. Drug-induced thrombocytopenia is briefly reviewed, and a possible mechanism responsible for causing this side effect of fenofibrate is suggested. This is the first reported case of fenofibrate-induced immune thrombocytopenia.

Severe neutropenia in a renal transplant patient suggesting an interaction between mycophenolate and fenofibrate.

OBJECTIVE: To describe a patient in whom initiation of micronized fenofibrate precipitated mycophenolate induced neutropenia. CASE SUMMARY: A 57-year-old man was admitted to the hospital because of febrile neutropenia. He had undergone kidney transplantation seventeen years ago. The patient's immunosuppressive maintenance regimen consisted of mycophenolate mofetil (MMF) 500 mg three times a day, and meprednisone 4 mg daily. His medical history included, hypertension treated with losartan 50mg daily, and dyslipidemia treated with ezetimibe 10mg /simvastatin 20mg for four years (until 2 weeks before admission when micronized fenofibrate 200 mg per day was started because of persistently elevated triglycerides levels. On presentation temperature was 37.8°C and initial laboratory tests showed 3130 White Blood Cell Count(WBC)/µL with neutropenia (absolute neutrophil count (ANC) 313/µL) Fenofibrate and mycophenolate mofetil were discontinued, piperacillin tazobactam 4.5gr three times a day and granulocyte stimulation factor 300 µg/day were started. Three days after admission WBC was 7280/µL, neutrophils: 22%, ANC: 1160/mm(3). Mycophenolate mofetil was restarted and granulocyte stimulation factor was discontinued. One month after discharge his WBC was 4480/µL and ANC 1926/µL. DISCUSSION: The initiation of fenofibrate in a patient on stable and therapeutic doses of mycophenolate may have precipitated mycophenolate induced neutropenia, a well described, dose dependent phenomenon. Mycophenolic acid (MPA) displays a complex pharmacokinetic profile susceptible to potential significant interactions with fenofibrate. Since approximately 99% of MPA and fenofibrate bind to albumin, displacement may occur, leading to increased free MPA. Second competition of fenofibric acid for UGT1A9 an enzyme implicated in conjugation of MPA may have decreased its metabolism. The combination of these two effects may increase the risk of dose dependent neutropenia. Using the Interaction Probability Scale (DIPS), the interaction was designated as probable. CONCLUSIONS: Until further evidence is available, when fenofibrate is started in a renal transplant patient on mycophenolate careful monitoring should be considered to avoid potentially fatal complications.

Fenofibrate-induced rhabdomyolysis in a patient with chronic kidney disease: an unusual presenting feature of hypothyroidism.

Clinical and most often moderate skeletal muscle involvement is a frequent problem in adults with hypothyroidism, and includes a number of different manifestations. Severe involvement with rhabdomyolysis, however, is very rare, and only a few cases have been reported to date, most of them with an additional factor of muscle injury. We described a patient with stage 3 chronic kidney disease who presented with rhabdomyolysis while taking fenofibrate, and was found to have hypothyroidism. We also highlighted the importance of excluding the diagnosis of thyroid dysfunction before treatment with lipid-lowering agents.

Fenofibrate-induced rhabdomyolysis in a patient with chronic kidney disease: an unusual presenting feature of hypothyroidism / Rabdomiólise induzida por fenofibrato em paciente com doença renal crônica: uma apresentação clínica incomum do hipotireoidismo

Clinical and most often moderate skeletal muscle involvement is a frequent problem in adults with hypothyroidism, and includes a number of different manifestations. Severe involvement with rhabdomyolysis, however, is very rare, and only a few cases have been reported to date, most of them with an additional factor of muscle injury. We described a patient with stage 3 chronic kidney disease who presented with rhabdomyolysis while taking fenofibrate, and was found to have hypothyroidism. We also highlighted the importance of excluding the diagnosis of thyroid dysfunction before treatment with lipid-lowering agents.

Manifestações musculoesqueléticas variadas e de moderada intensidade são comuns em adultos com hipotireoidismo. No entanto, o envolvimento muscular grave, caracterizado por rabdomiólise, é incomum. Até o momento, poucos casos foram descritos na literatura, e a maior parte deles em associação com um fator adicional de dano muscular. Descrevemos um paciente com doença renal crônica (estádio 3) que se apresentou com rabdomiólise durante o tratamento com fenofibrato e cuja investigação adicional evidenciou hipotireoidismo primário. Enfatizamos, ainda, a importância da exclusão de disfunção tireoidiana antes de iniciar terapia com agentes hipolipemiantes.

Pan-PPAR agonist beneficial effects in overweight mice fed a high-fat high-sucrose diet.

OBJECTIVE: We analyzed the effect of peroxisome proliferator-activated receptor (PPAR) agonists on adipose tissue morphology, adiponectin expression, and its relation to glucose and insulin levels in C57BL/6 mice fed a high-fat high-sucrose (HFHS) diet. METHODS: Male C57BL/6 mice received one of five diets: standard chow, HFHS chow, or HFHS plus rosiglitazone (PPAR-gamma agonist), fenofibrate (PPAR-alpha agonist), or bezafibrate (pan-PPAR agonist). Diets were administered for 11 wk and medications from week 6 to week 11. Glucose intolerance (GI) and insulin resistance were evaluated by oral glucose tolerance testing and homeostasis model assessment for insulin resistance, respectively. Adipocyte diameter was analyzed in epididymal, inguinal, and retroperitoneal fat pads and by adiponectin immunostain. RESULTS: Mice fed the HFHS chow had hyperglycemia, GI, insulin resistance, increased fat pad weight, adipocyte hypertrophy, and decreased adiponectin immunostaining. Rosiglitazone improved GI, insulin sensitiveness, and adiponectin immunostaining, but it resulted in body weight gain, hyperphagia, and adipocyte and heart hypertrophy. Fenofibrate improved all parameters except for fasting glucose and GI. Bezafibrate was the most efficient in decreasing body weight and glucose intolerance. CONCLUSION: Activation of PPAR-alpha, -delta, and -gamma together is better than the activation of PPAR-alpha or -gamma alone, because bezafibrate showed a wider range of action on metabolic, morphologic, and biometric alterations due to an HFHS diet in mice.

Efficacy and safety of ABT-335 (fenofibric acid) in combination with rosuvastatin in patients with mixed dyslipidemia: a phase 3 study.

OBJECTIVE: To evaluate a new formulation of fenofibric acid (ABT-335) co-administered with 2 doses of rosuvastatin in patients with mixed dyslipidemia. METHODS: In a phase 3, multicenter, randomized, double-blind, active-controlled study, a total of 1445 patients with LDL-C>or=130 mg/dL, TG>or=150 mg/dL, and HDL-C<40 mg/dL (<50 mg/dL for women) were randomized to either ABT-335 (135 mg), rosuvastatin (10, 20, or 40 mg), or ABT-335+rosuvastatin 10 or 20 mg, and treated for 12 weeks. The primary efficacy comparisons were mean percent change in HDL-C and TG (ABT-335+rosuvastatin vs. corresponding dose of rosuvastatin), and LDL-C (ABT-335+rosuvastatin vs. ABT-335). RESULTS: Combination therapy with ABT-335+rosuvastatin 10 mg resulted in significantly (p<0.001) greater improvements in HDL-C (20.3% vs. 8.5%) and TG (-47.1% vs. -24.4%) compared to rosuvastatin 10 mg; and LDL-C (-37.2% vs. -6.5%) compared to ABT-335. Similarly, significantly (p<0.001) greater improvements were observed with ABT-335+rosuvastatin 20 mg in HDL-C (19.0% vs. 10.3%) and TG (-42.9% vs. -25.6%) compared to rosuvastatin 20 mg; and LDL-C (-38.8% vs. -6.5%) compared to ABT-335 monotherapy. Greater improvements in multiple secondary endpoints were noted with combination therapy compared to prespecified monotherapies. Both combination therapy doses were generally well tolerated, with a safety profile consistent with ABT-335 and rosuvastatin monotherapies. No rhabdomyolysis or unexpected hepatic, renal, or muscle safety signals were identified. CONCLUSION: In patients with mixed dyslipidemia, combination therapy with ABT-335+rosuvastatin resulted in more effective control of multiple lipid parameters than either monotherapy alone, with a safety profile similar to both monotherapies. This combination may be an appropriate therapeutic option to treat mixed dyslipidemia.

Fenofibrate of gemfibrozil for treatment of types IIa and IIb primary hyperlipoproteinemia: a randomized, double-blind, crossover study.

OBJECTIVE: To compare the hypolipidemic effects of gemfibrozil and micronized fenofibrate in patients with primary hyperlipoproteinemia, phenotypes IIa and IIb, with emphasis on their cholesterol-lowering effectiveness. METHODS: A randomized, double-blind, double-dummy, crossover study was performed to assess the effects of gemfibrozil (900 mg) and micronized fenofibrate (200 mg), administered once daily, to 21 patients (45 to 70 years old)-16 with type IIa and 5 with type IIb primary hyperlipidemia. The two treatment periods lasted 6 weeks each; the run-in and washout periods were 4 weeks. RESULTS: Both drugs significantly reduced total cholesterol, calculated low-density lipoprotein (LDL) cholesterol, triglycerides, apolipoprotein B, and fibrinogen (P<0.01 for all calculations, except P<0.05 for fibrinogen with gemfibrozil therapy) and increased high-density lipoprotein (HDL) cholesterol (P<0.01). Neither drug affected Lp(a) lipoprotein, whereas uric acid was reduced only by fenofibrate (P<0.01). The percentage decrease in total cholesterol and LDL cholesterol was greater with fenofibrate than with gemfibrozil (-22% versus -15%, P<0.02; and -27% versus -16%, P<0.02, respectively). In contrast, reductions in levels of triglycerides (-54% versus -46.5%), apolipoprotein B, and fibrinogen, as well as the increase in HDL (+9% for both drugs), showed no significant difference between treatments. Separate analysis of patients with type IIb hyperlipoproteinemia showed essentially the same plasma lipid changes as for the overall group, but with greater modifications in triglyceride and HDL concentrations. CONCLUSION: Fenofibrate and gemfibrozil induced similar variations from baseline values in triglycerides, HDL cholesterol, apolipoprotein B, and fibrinogen, but the decreases in total and LDL cholesterol levels were greater with fenofibrate, in this group of patients with primary hyperlipidemia.

Bezafibrate and fenofibrate in type II diabetics with hyperlipoproteinaemia.

A double-blind study was carried out in 64 Type II diabetic patients, controlled with diet therapy and sulphonylureas (glibenclamide or chlorpropamide), who had associated hyperlipoproteinaemia which could not be normalized during a run-in period of 2 months by hygiene and dietary measures alone. The patients were allocated at random into 4 groups and each group was treated over 4 months with bezafibrate (600 mg/day) or fenofibrate (300 mg/day) in addition to their glibenclamide (5 to 15 mg/day) or chlorpropamide (250 to 500 mg/day) therapy plus diet. The results of monthly laboratory investigations showed that both hypolipaemic agents produced significant reductions in serum triglycerides, total cholesterol and LDL cholesterol and an increase in HDL cholesterol. There was a significantly greater increase in HDL cholesterol in patients treated with bezafibrate and glibenclamide, particularly in women, and greater control of blood glucose in those on bezafibrate. Both hypolipaemic drugs were well tolerated. Slight increases were recorded in serum transaminases in fenofibrate patients and in bleeding time in bezafibrate patients. It is concluded that, because of its greater effect on blood glucose and HDL cholesterol, the combination of bezafibrate with glibenclamide would appear to be the best of the regimens studied for the treatment of non-insulin-dependent diabetics with associated hyperlipoproteinaemia.