Evaluation of the effects of pemafibrate on metabolic dysfunction-associated steatotic liver disease with hypertriglyceridemia using magnetic resonance elastography combined with fibrosis-4 index and the magnetic resonance imaging-aspartate aminotransferase score

Takeshi Ichikawa; Haruki Oba; Mai Owada; Kazuki Watanabe; Tsubasa Yoshimura; Ayako Fuchigami; Atsushi Nakamura

doi:10.1002/jgh3.13012

Evaluation of the effects of pemafibrate on metabolic dysfunction-associated steatotic liver disease with hypertriglyceridemia using magnetic resonance elastography combined with fibrosis-4 index and the magnetic resonance imaging-aspartate aminotransferase score

JGH Open. 2023 Dec 11;7(12):959-965. doi: 10.1002/jgh3.13012. eCollection 2023 Dec.

Authors

Takeshi Ichikawa¹, Haruki Oba¹, Mai Owada¹, Kazuki Watanabe¹, Tsubasa Yoshimura¹, Ayako Fuchigami¹, Atsushi Nakamura¹

Affiliation

¹ Department of Gastroenterology and Hepatology Nippon Koukan Hospital Kawasaki Japan.

Abstract

Background and aim: In this retrospective study, we evaluated the effects of pemafibrate treatment in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and hypertriglyceridemia using non-invasive stiffness-based models, including magnetic resonance elastography (MRE) combined with the fibrosis-4 (FIB-4) (MEFIB) index and the magnetic resonance imaging (MRI)-aspartate aminotransferase (AST) (MAST) score.

Methods: In total, 179 patients with MASLD treated with pemafibrate were enrolled. We evaluated the effects of 48-week pemafibrate treatment using the MEFIB index, which classifies patients based on the combination of liver stiffness measurement (LSM) on MRE and FIB-4 and the MAST score, which is calculated based on LSM on MRE, MRI-proton density fat fraction (MRI-PDFF), and AST levels.

Results: Pemafibrate treatment led to significant reduction in AST, alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT) (P = 0.011, <0.001, and <0.001, respectively) and significant improvements in triglyceride and high-density lipoprotein cholesterol levels (P < 0.001 and <0.001, respectively). The MRI-PDFF values were not significantly altered. However, a significant decrease in LSM on MRE was detected (P = 0.003). Evaluation of fibrosis using the MEFIB index and MAST score demonstrated significant improvement (P = 0.004 and <0.001, respectively). Changes in the MAST score showed positive correlation with changes in ALT and GGT levels (r = 0.821, P < 0.001, and r = 0.808, P < 0.001, respectively). Additionally, ALT and GGT levels at baseline were significantly associated with improvements in the MAST score (P < 0.001 and <0.001, respectively).

Conclusion: Pemafibrate led to improvements in the MEFIB index and MAST score, as well as liver function. It is a promising therapeutic agent for patients with MASLD and hypertriglyceridemia with the potential to reduce liver-related events.

Keywords: hyperglyceridemia; magnetic resonance elastography combined with fibrosis‐4 index; magnetic resonance imaging‐aspartate aminotransferase score; metabolic dysfunction‐associated steatotic liver disease; pemafibrate.