Short-term effect of fenofibrate on C-reactive protein: A meta-analysis of randomized controlled trials

Abstract

BackgroundC-reactive protein (CRP) is positively associated with risk for cardiovascular disease and all-cause mortality. Some but not all randomized and non-randomized clinical trials found significant associations between fenofibrate therapy and CRP but the direction and magnitude of the association varied across studies. The duration of treatment, patient populations and sample sizes varied greatly, and most short-term studies (i.e., ≤ 12 weeks) had fewer than 50 patients. In this study we meta-analyzed randomized clinical trials to determine the short-term effect of fenofibrate on CRP.MethodsTwo reviewers independently searched PubMed and other online databases for short-term randomized clinical trials that reported CRP concentrations before and after fenofibrate treatment. Of the 81 studies examined, 14 studies with 540 patients were found eligible. Data for the change in CRP and corresponding measures of dispersion were extracted for use in the meta-analysis.ResultsThe weighted mean CRP concentrations before and after fenofibrate therapy were 2.15 mg/L and 1.53 mg/L (-28.8% change), respectively. Inverse-variance weighted random effects meta-analysis revealed that short-term fenofibrate treatment significantly lowers CRP by 0.58 mg/L (95% CI: 0.36-0.80). There was significant heterogeneity between studies (Q statistic = 64.5, P< 0.0001, I2 = 79.8%). There was no evidence of publication bias and sensitivity analysis revealed that omitting any of the 14 studies did not lead to a different conclusion from the overall meta-analysis result.ConclusionShort-term treatment with fenofibrate significantly lowers CRP concentration. Randomized trials that will recruit patients based with high baseline CRP concentrations and with change in CRP as a primary outcome are needed.

Effect of L-Carnitine Supplementation on Circulating C-Reactive Protein Levels: A Systematic Review and Meta-Analysis / Uticaj Suplementacije L-Karnitinom Na Nivoe C-Reaktivnog Proteina U Cirkulaciji: Sistematski Pregled I Metaanaliza

“…Findings from the sensitivity analysis implied that the detected significance for the efficacy of L-carnitine is robust and not considerably affected by a single study. It is interesting to note that the weighted pooled estimate for the effect of L-carnitine on circulating levels of CRP is greater than those reported from previous meta-analyses on soy isoflavones ( 40 ) and telmisartan ( 41 ), but lower than those of fibrates ( 42 ) and statins ( 6 ).…”

Fenofibrate/simvastatin fixed-dose combination in the treatment of mixed dyslipidemia: safety, efficacy, and place in therapy

“…Also, other studies showed antithrombotic and fibrinolytic properties of fenofibrate (decrease in PAI and fibrinogen), 54 neo-angiogenesis reduction, and, on the other side, increase of flow-mediated dilation consistent with beneficial improvement of nitric oxide production, as proved in vitro. 44 …”

“…Last, markers of inflammation as CRP, interleukins (mostly interleukin-6 [IL-6] and tumor necrosis factor-α [TNF-α]), adhesion molecules (VCAM and ICAM) and uric acid were reduced with the administration of fenofibrate in a high-risk group. 52 – 54 …”

The Emerging Role of Inflammation in Cardiovascular Disease

“…Impact of Drugs on hsCRP. 3,[23][24][25][26][27][28][29][30]43 Drug or Class Magnitude of hsCRP Reduction Aspirin, 23 ACE inhibitors, [24][25][26] fibrates 28~2 0%-30% Statins 29~3 0%-50% Canakinumab 3,43~4 0%-60% [~25%-40% when combined with ACE inhibitors and statins] Methotrexate 30~7 0%…”