Fenofibrate

A review of its use in dyslipidaemia

Kate McKeage, Gillian M. Keating, D. Bhatnagar, M. B. Elam, M. Farnier, Syed M. Mohiuddin

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

Fenofibrate is a fibric acid derivative indicated for the treatment of severe hypertriglyceridaemia and mixed dyslipidaemia in patients who have not responded to nonpharmacological therapies. The lipid-modifying effects of fenofibrate are mediated by the activation of peroxisome proliferator-activated receptor-α. Fenofibrate also has nonlipid, pleiotropic effects (e.g. reducing levels of fibrinogen, C-reactive protein and various pro-inflammatory markers, and improving flow-mediated dilatation) that may contribute to its clinical efficacy, particularly in terms of improving microvascular outcomes. Fenofibrate improves the lipid profile (particularly triglyceride TG and high-density lipoprotein-cholesterol HDL-C levels) in patients with dyslipidaemia. Compared with statin monotherapy, fenofibrate monotherapy tends to improve TG and HDL-C levels to a significantly greater extent, whereas statins improve low-density lipoprotein-cholesterol (LDL-C) and total cholesterol levels to a significantly greater extent. Fenofibrate is also associated with promoting a shift from small, dense, atherogenic LDL particles to larger, less dense LDL particles. Combination therapy with a statin plus fenofibrate generally improves the lipid profile to a greater extent than monotherapy with either agent in patients with dyslipidaemia andor type 2 diabetes mellitus or the metabolic syndrome. In the pivotal FIELD and ACCORD trials in patients with type 2 diabetes, fenofibrate did not significantly reduce the risk of coronary heart disease events to a greater extent than placebo, and simvastatin plus fenofibrate did not significantly reduce the risk of major cardiovascular (CV) events to a greater extent than simvastatin plus placebo. However, the risk of some nonfatal macrovascular events and the incidence of certain microvascular outcomes were reduced significantly more with fenofibrate than with placebo in the FIELD trial, and in the ACCORD trial, patients receiving simvastatin plus fenofibrate were less likely to experience progression of diabetic retinopathy than those receiving simvastatin plus placebo. Subgroup analyses in the FIELD and ACCORD Lipid trials indicate that fenofibrate is of the greatest benefit in decreasing CV events in patients with atherogenic dyslipidaemia. Fenofibrate is generally well tolerated when administered alone or in combination with a statin. Thus, in patients with dyslipidaemia, particularly atherogenic dyslipidaemia, fenofibrate is a useful treatment option either alone or in combination with a statin.

Original languageEnglish
Pages (from-to)1917-1946
Number of pages30
JournalDrugs
Volume71
Issue number14
DOIs
StatePublished - 2011

Fingerprint

Fenofibrate
Dyslipidemias
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Simvastatin
Placebos
Lipids
Type 2 Diabetes Mellitus
Fibric Acids
Peroxisome Proliferator-Activated Receptors
Hypertriglyceridemia
Proxy
Diabetic Retinopathy
Therapeutics
C-Reactive Protein

All Science Journal Classification (ASJC) codes

  • Pharmacology (medical)

Cite this

McKeage, K., Keating, G. M., Bhatnagar, D., Elam, M. B., Farnier, M., & Mohiuddin, S. M. (2011). Fenofibrate: A review of its use in dyslipidaemia. Drugs, 71(14), 1917-1946. https://doi.org/10.2165/11208090-000000000-00000

Fenofibrate : A review of its use in dyslipidaemia. / McKeage, Kate; Keating, Gillian M.; Bhatnagar, D.; Elam, M. B.; Farnier, M.; Mohiuddin, Syed M.

In: Drugs, Vol. 71, No. 14, 2011, p. 1917-1946.

Research output: Contribution to journalArticle

McKeage, K, Keating, GM, Bhatnagar, D, Elam, MB, Farnier, M & Mohiuddin, SM 2011, 'Fenofibrate: A review of its use in dyslipidaemia', Drugs, vol. 71, no. 14, pp. 1917-1946. https://doi.org/10.2165/11208090-000000000-00000
McKeage K, Keating GM, Bhatnagar D, Elam MB, Farnier M, Mohiuddin SM. Fenofibrate: A review of its use in dyslipidaemia. Drugs. 2011;71(14):1917-1946. https://doi.org/10.2165/11208090-000000000-00000
McKeage, Kate ; Keating, Gillian M. ; Bhatnagar, D. ; Elam, M. B. ; Farnier, M. ; Mohiuddin, Syed M. / Fenofibrate : A review of its use in dyslipidaemia. In: Drugs. 2011 ; Vol. 71, No. 14. pp. 1917-1946.
@article{d6e46e946c194e339dbb30ba81e33746,
title = "Fenofibrate: A review of its use in dyslipidaemia",
abstract = "Fenofibrate is a fibric acid derivative indicated for the treatment of severe hypertriglyceridaemia and mixed dyslipidaemia in patients who have not responded to nonpharmacological therapies. The lipid-modifying effects of fenofibrate are mediated by the activation of peroxisome proliferator-activated receptor-α. Fenofibrate also has nonlipid, pleiotropic effects (e.g. reducing levels of fibrinogen, C-reactive protein and various pro-inflammatory markers, and improving flow-mediated dilatation) that may contribute to its clinical efficacy, particularly in terms of improving microvascular outcomes. Fenofibrate improves the lipid profile (particularly triglyceride TG and high-density lipoprotein-cholesterol HDL-C levels) in patients with dyslipidaemia. Compared with statin monotherapy, fenofibrate monotherapy tends to improve TG and HDL-C levels to a significantly greater extent, whereas statins improve low-density lipoprotein-cholesterol (LDL-C) and total cholesterol levels to a significantly greater extent. Fenofibrate is also associated with promoting a shift from small, dense, atherogenic LDL particles to larger, less dense LDL particles. Combination therapy with a statin plus fenofibrate generally improves the lipid profile to a greater extent than monotherapy with either agent in patients with dyslipidaemia andor type 2 diabetes mellitus or the metabolic syndrome. In the pivotal FIELD and ACCORD trials in patients with type 2 diabetes, fenofibrate did not significantly reduce the risk of coronary heart disease events to a greater extent than placebo, and simvastatin plus fenofibrate did not significantly reduce the risk of major cardiovascular (CV) events to a greater extent than simvastatin plus placebo. However, the risk of some nonfatal macrovascular events and the incidence of certain microvascular outcomes were reduced significantly more with fenofibrate than with placebo in the FIELD trial, and in the ACCORD trial, patients receiving simvastatin plus fenofibrate were less likely to experience progression of diabetic retinopathy than those receiving simvastatin plus placebo. Subgroup analyses in the FIELD and ACCORD Lipid trials indicate that fenofibrate is of the greatest benefit in decreasing CV events in patients with atherogenic dyslipidaemia. Fenofibrate is generally well tolerated when administered alone or in combination with a statin. Thus, in patients with dyslipidaemia, particularly atherogenic dyslipidaemia, fenofibrate is a useful treatment option either alone or in combination with a statin.",
author = "Kate McKeage and Keating, {Gillian M.} and D. Bhatnagar and Elam, {M. B.} and M. Farnier and Mohiuddin, {Syed M.}",
year = "2011",
doi = "10.2165/11208090-000000000-00000",
language = "English",
volume = "71",
pages = "1917--1946",
journal = "Drugs",
issn = "0012-6667",
publisher = "Adis International Ltd",
number = "14",

}

TY - JOUR

T1 - Fenofibrate

T2 - A review of its use in dyslipidaemia

AU - McKeage, Kate

AU - Keating, Gillian M.

AU - Bhatnagar, D.

AU - Elam, M. B.

AU - Farnier, M.

AU - Mohiuddin, Syed M.

PY - 2011

Y1 - 2011

N2 - Fenofibrate is a fibric acid derivative indicated for the treatment of severe hypertriglyceridaemia and mixed dyslipidaemia in patients who have not responded to nonpharmacological therapies. The lipid-modifying effects of fenofibrate are mediated by the activation of peroxisome proliferator-activated receptor-α. Fenofibrate also has nonlipid, pleiotropic effects (e.g. reducing levels of fibrinogen, C-reactive protein and various pro-inflammatory markers, and improving flow-mediated dilatation) that may contribute to its clinical efficacy, particularly in terms of improving microvascular outcomes. Fenofibrate improves the lipid profile (particularly triglyceride TG and high-density lipoprotein-cholesterol HDL-C levels) in patients with dyslipidaemia. Compared with statin monotherapy, fenofibrate monotherapy tends to improve TG and HDL-C levels to a significantly greater extent, whereas statins improve low-density lipoprotein-cholesterol (LDL-C) and total cholesterol levels to a significantly greater extent. Fenofibrate is also associated with promoting a shift from small, dense, atherogenic LDL particles to larger, less dense LDL particles. Combination therapy with a statin plus fenofibrate generally improves the lipid profile to a greater extent than monotherapy with either agent in patients with dyslipidaemia andor type 2 diabetes mellitus or the metabolic syndrome. In the pivotal FIELD and ACCORD trials in patients with type 2 diabetes, fenofibrate did not significantly reduce the risk of coronary heart disease events to a greater extent than placebo, and simvastatin plus fenofibrate did not significantly reduce the risk of major cardiovascular (CV) events to a greater extent than simvastatin plus placebo. However, the risk of some nonfatal macrovascular events and the incidence of certain microvascular outcomes were reduced significantly more with fenofibrate than with placebo in the FIELD trial, and in the ACCORD trial, patients receiving simvastatin plus fenofibrate were less likely to experience progression of diabetic retinopathy than those receiving simvastatin plus placebo. Subgroup analyses in the FIELD and ACCORD Lipid trials indicate that fenofibrate is of the greatest benefit in decreasing CV events in patients with atherogenic dyslipidaemia. Fenofibrate is generally well tolerated when administered alone or in combination with a statin. Thus, in patients with dyslipidaemia, particularly atherogenic dyslipidaemia, fenofibrate is a useful treatment option either alone or in combination with a statin.

AB - Fenofibrate is a fibric acid derivative indicated for the treatment of severe hypertriglyceridaemia and mixed dyslipidaemia in patients who have not responded to nonpharmacological therapies. The lipid-modifying effects of fenofibrate are mediated by the activation of peroxisome proliferator-activated receptor-α. Fenofibrate also has nonlipid, pleiotropic effects (e.g. reducing levels of fibrinogen, C-reactive protein and various pro-inflammatory markers, and improving flow-mediated dilatation) that may contribute to its clinical efficacy, particularly in terms of improving microvascular outcomes. Fenofibrate improves the lipid profile (particularly triglyceride TG and high-density lipoprotein-cholesterol HDL-C levels) in patients with dyslipidaemia. Compared with statin monotherapy, fenofibrate monotherapy tends to improve TG and HDL-C levels to a significantly greater extent, whereas statins improve low-density lipoprotein-cholesterol (LDL-C) and total cholesterol levels to a significantly greater extent. Fenofibrate is also associated with promoting a shift from small, dense, atherogenic LDL particles to larger, less dense LDL particles. Combination therapy with a statin plus fenofibrate generally improves the lipid profile to a greater extent than monotherapy with either agent in patients with dyslipidaemia andor type 2 diabetes mellitus or the metabolic syndrome. In the pivotal FIELD and ACCORD trials in patients with type 2 diabetes, fenofibrate did not significantly reduce the risk of coronary heart disease events to a greater extent than placebo, and simvastatin plus fenofibrate did not significantly reduce the risk of major cardiovascular (CV) events to a greater extent than simvastatin plus placebo. However, the risk of some nonfatal macrovascular events and the incidence of certain microvascular outcomes were reduced significantly more with fenofibrate than with placebo in the FIELD trial, and in the ACCORD trial, patients receiving simvastatin plus fenofibrate were less likely to experience progression of diabetic retinopathy than those receiving simvastatin plus placebo. Subgroup analyses in the FIELD and ACCORD Lipid trials indicate that fenofibrate is of the greatest benefit in decreasing CV events in patients with atherogenic dyslipidaemia. Fenofibrate is generally well tolerated when administered alone or in combination with a statin. Thus, in patients with dyslipidaemia, particularly atherogenic dyslipidaemia, fenofibrate is a useful treatment option either alone or in combination with a statin.

UR - http://www.scopus.com/inward/record.url?scp=80053185929&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80053185929&partnerID=8YFLogxK

U2 - 10.2165/11208090-000000000-00000

DO - 10.2165/11208090-000000000-00000

M3 - Article

VL - 71

SP - 1917

EP - 1946

JO - Drugs

JF - Drugs

SN - 0012-6667

IS - 14

ER -