NEW ORLEANS — Gemfibrozil produces multiple benefits in children with severe metabolic syndrome, including a sharp reduction in triglyceride levels, increased HDL cholesterol levels, and a decrease in elevated liver enzymes, Courtney M. Smalley reported at the annual meeting of the American College of Cardiology.
The gemfibrozil-induced decrease in the elevated levels of alanine transaminase, aspartate transaminase, or both often present in children with severe metabolic syndrome suggests the fibrate therapy may reverse nonalcoholic steatohepatitis. This possibility has not been confirmed by liver biopsy, said Ms. Smalley, a medical student at the University of Arizona, Tucson.
She reported on 40 children with severe metabolic syndrome, mean age 13 years, who were placed on 600 mg gemfibrozil twice daily. After a mean 8.3 months on the fibrate, their triglyceride levels were down by 54% from a baseline of 388 mg/dL, and their mean HDL climbed by 17% from 36 to 42 mg/dL. Thirty of the subjects had evidence of fatty deposition in the liver at baseline from liver biopsy, elevated liver enzymes, or both. Gemfibrozil cut alanine transaminase by 38% from a baseline of 57 IU/L and aspartate transaminase by 28% from a baseline of 39 IU/L. Waist circumference, body mass index, and percent body fat did not change significantly.
This was an off-label use of gemfibrozil, which has not been studied in children with metabolic syndrome. It was selected for the study because it is inexpensive, easy-to-use, and has been around a long time. The fibrates' lipid-modifying effects make this drug class a better choice than statins for patients with the high triglyceride/low HDL lipid profile characteristic of the metabolic syndrome, Ms. Smalley said in an interview. Two patients developed myalgia within the first week of therapy and were taken off the drug. None reported gastric upset, a major side effect in adults on gemfibrozil.