fibrate
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Introduction
Also see individual agent.
Indications
- used largely for treatment of hypertriglyceridemia
- in combination with bile acid sequestrant resin for familial combined hyperlipidemia
* lowers risk of non-fatal myocardial infarction in patients not taking statins[7]
* does not lower risk of fatal myocardial infarctions, stroke or all-cause mortality in patients taking statins[7][10]
* reduces risk for stroke, but not coronary events, in elderly without cardiovascular disease[8]
Monitor
- liver function tests
- serum triglycerides every 2 months[2]
- renal function during 1st few months[5]
Adverse effects
Mechanism of action
- 35% reduction in triglycerides
- 10% reduction in LDL cholesterol
- 10% increase in HDL cholesterol
Clinical trials
- appears to lower the risk for coronary events (benefit modest but may be clinically significant for high risk patients)[3]
- no benefit in terms of stroke, mortality, or heart failure
- lack of evidence to support adjunct to statin therapy[4][10]
- may result in improved lipid profiles in patients with mild-to-moderate chronic kidney disease (meta-analysis)[6]
- does not lower cardiovascular mortality[10]
- does not lower overall mortality
- may slow progression of albuminuria
- does not lower LDL cholesterol
- may increase serum creatinine & decrease GFR[6]
More general terms
More specific terms
- bezafibrate (Bezalip)
- clofibrate (Atromid-S)
- fenofibrate (Antara, TriCor, Triglide, Lofibra, Proctofene, Trilipix)
- gemfibrozil (Lopid)
- pemafibrate
Additional terms
References
- ↑ Principles of Geriatric Medicine & Gerontology, 4th ed, Hazzard et al (eds), McGraw-Hill, 1999
- ↑ 2.0 2.1 deprecated reference
- ↑ 3.0 3.1 Jun M et al, Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis. The Lancet, Early Online Publication, 11 May 2010 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20462635 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60656-3/fulltext
- ↑ 4.0 4.1 Jackevicius CA et al. Use of fibrates in the United States and Canada. JAMA 2011 Mar 23/30; 305:1217 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21427374
- ↑ 5.0 5.1 Zhao YY et al New Fibrate Use and Acute Renal Outcomes in Elderly Adults A Population-Based Study Annals of Internal Medicine 2012 156(8):560-569 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22508733 <Internet> http://www.annals.org/content/156/8/560.abstract
- ↑ 6.0 6.1 6.2 Jun M et al. Effects of fibrates in kidney disease: A systematic review and meta-analysis. J Am Coll Cardiol 2012 Nov 13; 60:2061 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23083786 <Internet> http://www.sciencedirect.com/science/article/pii/S0735109712043161
McCullough PA and Di Loreto MJ. Fibrates and cardiorenal outcomes. J Am Coll Cardiol 2012 Nov 13; 60:2072. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23083778 <Internet> http://www.sciencedirect.com/science/article/pii/S0735109712043148 - ↑ 7.0 7.1 7.2 Keene D et al. Effect on cardiovascular risk of high density lipoprotein targeted drug treatments niacin, fibrates, and CETP inhibitors: Meta-analysis of randomised controlled trials including 117,411 patients. BMJ 2014 Jul 18; 349:g4379 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25038074
- ↑ 8.0 8.1 Mueller PS Lipid-Lowering Drugs for Primary Prevention in Older Adults NEJM Journal Watch. June 4, 2015 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
Alperovitch A et al. Primary prevention with lipid lowering drugs and long term risk of vascular events in older people: Population based cohort study. BMJ 2015 May 19; 350:h2335 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25989805 - ↑ 9.0 9.1 Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
- ↑ 10.0 10.1 10.2 10.3 Boswoth T Triglyceride Lowering Fails to Show CV Benefit in Large Fibrate Trial. Twenty-Five Percent Reduction Has No Effect. Medscape. Nov 5, 2022 https://www.medscape.com/viewarticle/983610
Das Pradhan A et al. Triglyceride lowering with pemafibrate to reduce cardiovascular risk. N Engl J Med 2022 Nov 5; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36342113 https://www.nejm.org/doi/10.1056/NEJMoa2210645