ArticleFrontiers in clinical diabetes and healthcare2026
Pemafibrate is associated with greater reductions in MDA-LDL and small dense LDL fractions with exploratory PBMC gene-expression changes: a prespecified subanalysis of the PARADISE in Kagoshima study.
Article in Frontiers in clinical diabetes and healthcare, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Pemafibrate, a selective peroxisome proliferator-activated receptor alpha (PPARα) modulator, lowers triglycerides and improves lipid parameters. However, its effects on oxidized LDL-related markers, including malondialdehyde-modified low-density lipoprotein (MDA-LDL), and associated Methods: In this prespecified subanalysis of the randomized, open-label, parallel-group PARADISE in Kagoshima study, 51 participants assigned to pemafibrate and 46 assigned to eicosapentaenoic acid (EPA) were included in the clinical analysis. All participants had type 2 diabetes and hypertriglyceridemia and received treatment for 16 weeks. We evaluated changes in MDA-LDL, lipoprotein fractions including small dense LDL-related fractions, and exploratory peripheral blood mononuclear cell (PBMC) gene expression. PBMC gene expression was assessed in 11 participants in the Pemafibrate group and 7 in the EPA group, and was considered exploratory and hypothesis-generating. Results: Compared with EPA, pemafibrate produced a significantly greater reduction in triglycerides (least-squares mean difference, -79.2 mg/dL; 95% confidence interval [CI], -117 to -41.5; P < 0.001), and a greater increase in HDL-C (4.64 mg/dL; 95% CI, 2.43 to 6.84; P < 0.001). The mean change in MDA-LDL from baseline to week 16 was -30.3 ± 32.4 U/L in the Pemafibrate group and -9.2 ± 44.3 U/L in the EPA group, yielding a least-squares mean difference of -21.2 U/L (95% CI, -36.9 to -5.4; P = 0.009). In the exploratory PBMC analysis, ABCA1 and LCAT remained significant after false discovery rate adjustment, whereas other genes showed only nominal differences. Conclusion: Pemafibrate was associated with greater 16-week reductions in MDA-LDL and small dense LDL fractions than EPA in patients with type 2 diabetes and hypertriglyceridemia. These findings suggest modification of selected lipid-quality biomarkers. Their clinical relevance remains to be established.
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