Effectiveness and safety of prolonged fenofibrate therapy after the acute phase of hypertriglyceridemic pancreatitis

This study evaluated the association of prolonged fenofibrate therapy with recurrent hypertriglyceridemic pancreatitis (HTGP), long-term triglyceride control, and safety during follow-up. This single-center retrospective cohort study included consecutive patients with HTGP diagnosed between January 2023 and December 2024. Patients who survived the index hospitalization and had post-discharge follow-up data were classified into a prolonged fenofibrate group or a control group according to treatment status. Prolonged fenofibrate therapy was defined as documented continuous use for at least 3 months after discharge. The primary outcome was recurrent HTGP. Secondary outcomes included time to 1st recurrence, descriptive crude recurrence proportions at 6, 12, and 24 months, pancreatitis-related readmission, recurrent hospital stay, follow-up triglyceride (TG) control, and safety outcomes. A total of 200 patients were included, including 107 in the prolonged fenofibrate group and 93 controls. Recurrent HTGP occurred in 17 patients (15.9%) in the fenofibrate group and 24 (25.8%) in the control group. Recurrence was numerically lower with fenofibrate, but the crude comparison was not statistically significant ( P = .081). Kaplan–Meier analysis showed a similar numerical trend toward better recurrence-free survival (log-rank P = .067). In multivariable Cox regression, prolonged fenofibrate therapy showed a potential association with lower recurrence risk, but the estimate was not statistically significant (adjusted hazard ratio 0.58, 95% confidence interval 0.31–1.07, P = .082). Previous HTGP remained independently associated with recurrence (adjusted hazard ratio 1.96, 95% confidence interval 1.06–3.63, P = .032). Follow-up TG levels were lower in the fenofibrate group (3.9 [2.5–6.2] vs 5.1 [3.0–8.4] mmol/L, P = .012), and more patients achieved TG < 5.6 mmol/L (69.2% vs 53.8%, P = .026). Safety outcomes were comparable between groups. Prolonged fenofibrate therapy after HTGP was associated with improved long-term triglyceride control and an acceptable safety profile. Recurrence-related outcomes consistently favored fenofibrate numerically, but none reached statistical significance. Larger prospective multicenter studies are needed to clarify any effect on recurrence.