ALT Reduction Following Pemafibrate Treatment in MASLD and MetALD with Dyslipidemia: Associations with the Baseline Liver Enzyme Levels.

Objective Pemafibrate improves the liver function and lipid profiles in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). However, the data on metabolic dysfunction and alcohol-associated steatotic liver disease (MetALD) remain limited. This study evaluated the biochemical changes after pemafibrate treatment in both conditions with dyslipidemia, focusing on alanine aminotransferase (ALT) reduction and the factors associated with the treatment response. Methods This retrospective, single-center cohort study analyzed changes in liver function tests, lipid profiles, and body mass index after 24 weeks of pemafibrate treatment. The factors associated with ALT reduction were assessed using correlation and multivariate regression analyses. Patients were classified as ALT responders or non-responders based on ALT changes at 24 weeks. Patients Ninety-six patients with MASLD and 14 with MetALD were included in the study. Results After 24 weeks, the liver function tests and lipid profiles improved significantly in patients with MASLD, and similar changes were observed in the MetALD subgroup. The median ALT reduction rate was -24.75%. Baseline ALT, AST, and GGT levels correlated with the ALT reduction rate, but none remained significant in the multivariable model using continuous liver enzyme variables. ALT reduction was greater in the MetALD subgroup, although this finding requires further exploration. Conclusion Pemafibrate treatment was associated with an improved liver function and lipid profiles in patients with MASLD complicated by dyslipidemia. The findings in the small MetALD subgroup were exploratory. Baseline ALT, AST, and GGT levels were correlated with ALT reduction, but none were independent predictors in the multivariable model.