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

Abstract

Background and AimIn 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.MethodsIn 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.ResultsPemafibrate 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).ConclusionPemafibrate 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.