Comparative Effectiveness of Fish Oil Versus Fenofibrate, Gemfibrozil, and Atorvastatin on Lowering Triglyceride Levels Among HIV-Infected Patients in Routine Clinical Care

Abstract

Objective The goal of this study was to compare the effectiveness of fish oil, fenofibrate, gemfibrozil, and atorvastatin on reducing triglyceride (TG) levels among a large cohort of HIV-infected patients in clinical care. Design Retrospective observational cohort study Methods The primary endpoint was absolute change in TG levels measured using the last TG value pre-treatment and the first TG value post-treatment. A pre-post quasi-experimental design was used to estimate the change in TG due to initiating fish oil. Linear regression models examined the comparative effectiveness of treatment with fish oil versus gemfibrozil, fenofibrate, or atorvastatin for TG reduction. Models were adjusted for baseline differences in age, sex, race, CD4+ cell count, diabetes, body mass index, protease inhibitor use, and time between TG measures. Results A total of 493 patients (mean age 46 years; 95% male) were included (46 receiving gemfibrozil, 80 fenofibrate, 291 atorvastatin, 76 fish oil) with a mean baseline TG of 347 mg/dL. New use of fish oil decreased TG (ΔTG -45 mg/dL 95% Confidence interval (CI):-80 to -11) in the pre-post study. Compared with fish oil (reference), fibrates were more effective (ΔTG -66; 95% CI:-120 to -12) in reducing TG levels, whereas atorvastatin was not (ΔTG -39; 95% CI:-86 to 9). Conclusion In HIV-infected patients in routine clinical care, fish oil is less effective than fibrates (but not atorvastatin) at lowering triglyceride values. Fish oil may still represent an attractive alternative for patients with moderately elevated triglycerides particularly among patients who may not want or tolerate fibrates.

Over-the-counter fish oil use in a county hospital: Medication use evaluation and efficacy analysis

“…A recent retrospective study of human immunodeficiency virus–infected patients, in the Centers for AIDS Research Network of Integrated Clinical Systems Cohort, analyzed the effects of fish oil with methods similar to ours, extracting data from EMR and pharmacy databases. 17 They reported greater TG lowering with fibrates compared with fish oil: adjusted percentage reduction in TG levels between fenofibrate (n = 80) vs fish oil (n = 76) of 16% ( P = .04) and between gemfibrozil (n = 46) and fish oil (n = 76) of 19% ( P = .04). Similar to our findings, patients prescribed fish oil had significantly lower pretreatment TG levels than those prescribed fibrates (366 mg/dL in fish oil vs 467 mg/dL in fenofibrate vs 440 mg/dL in gemfibrozil, P < .01), and the average time between pre-TG and post-TG measurements was roughly 5 months.…”

Management of lipid disorders in patients living with HIV

“…A recent retrospective observational cohort study compared the effectiveness of multiple treatment interventions in reducing triglycerides in 493 HIV‐infected patients with a mean TG of 347 mg/dL at baseline. The study showed that fibrate use resulted in larger TG level reductions than fish oil while TG did not change significantly with atorvastatin compared with fish oil use alone …”

Therapeutic Potential of Topical Fenofibrate Eyedrops in Diabetic Retinopathy and AMD Rat Models

“…As an anti-lipid oral drug, fenofibrate is primarily used in patients with metabolic disorders and dyslipidemia, including type 2 diabetic patients, and is typically taken once daily [27]. Most patients on fenofibrate have also taken statins to modify their cholesterol levels.…”