Effects of Pemafibrate on Liver Fibrosis in Patients with MASLD and Hypertriglyceridemia: A 2-Year Retrospective Observational Study Using MR Elastography

BACKGROUND: Pemafibrate, a selective peroxisome proliferator-activated receptor α modulator, has shown potent triglyceride-lowering effects. However, evidence regarding its long-term effects on liver fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD) remains limited. OBJECTIVE: Using magnetic resonance elastography (MRE), we evaluated the effects of 2-year pemafibrate treatment on liver fibrosis in patients with MASLD and hypertriglyceridemia. METHODS: This single-center retrospective study included 25 patients with MASLD and hypertriglyceridemia who received pemafibrate for ≥2 years and underwent MRE-based liver stiffness measurements (MRE-LSMs) before and after treatment. The primary endpoint was the change in MRE-LSMs over 2 years. Secondary endpoints included changes in lipid parameters, liver enzyme levels, liver function parameters, serum fibrosis markers, and the proton density fat fraction. Responders were defined as those showing ≥19% reduction in MRE-LSMs. RESULTS: The median MRE-LSM decreased significantly from 3.05 to 2.52 kPa (P < .001), with 92% of the patients showing improvement and 36% meeting the responder criteria. The proportion of patients showing significant fibrosis decreased from 44.0% to 28.0%. The triglyceride levels decreased from 231 to 125 mg/dL (P < .001). The liver enzyme levels, liver function parameters, and serum fibrosis markers improved significantly. These improvements occurred without changes in body weight, glycemic control, or hepatic fat content. No treatment discontinuations occurred due to adverse events. CONCLUSION: Two-year pemafibrate treatment significantly improved liver stiffness and hepatic parameters independent of weight loss or fat reduction, indicating potential antifibrotic mechanisms. These real-world findings support the hepatoprotective role of pemafibrate and warrant validation in prospective trials.