Long-term effects of switching from fenofibrate to pemafibrate for asymptomatic primary biliary cholangitis (aPBC)

The standard treatment for aPBC is to combine a fibrate with UDCA. Bezafibrate and fenofibrate are fibrates that elevate serum creatinine levels while decreasing the estimated glomerular filtration rate (eGFR). Pemafibrate is a selective peroxisome proliferator-activated receptor α modulator, which is primarily metabolized by the liver. This study assessed the effects of switching from fenofibrate to pemafibrate treatment in 16 aPBC patients over 144 weeks. In patients with aPBC treated with fenofibrate, serum creatinine levels increased significantly, while eGFR decreased significantly over 48 weeks. Moreover, patients with aPBC who switched to pemafibrate had significantly lower serum creatinine levels and higher eGFR over 144 weeks. Pemafibrate may be another option for aPBC patients, given its beneficial effects on renal function.