Efficacy of a micronized, nanocrystal fenofibrate formulation in treatment of hyperlipidemia in dogs

Pre and post fibrate supplementation lipoprotein electrophoresis in hyperlipemic dogs with biliary tree disease

Hyperlipemia is commonly observed in dogs with biliary tree disease, where cholestasis can both cause and result of hyperlipidemia. Fibrate therapy effectively reduce lipemia in dogs with both primary and secondary hyperlipidemia. This study aimed to investigate whether fenofibrate therapy could alter lipoprotein patterns in hyperlipemic cholestatic dogs. Retrospective cohort study on left-over frozen-stored (-80 °C) serum samples of 25 client-owned dogs with chronic biliary disease with hyperlipidemia (hypercholesterolemia and/or hypertriglyceridemia) that underwent fenofibrate therapy at 4-10 mg/kg once daily (T0) and had a re-check after 4-6 weeks (T1). To be included, dogs with hypercholesterolemia (>280 mg/dL) and/or hypertriglyceridemia (>90 mg/dL) had to present a concurrent increase of two or more between alkaline phosphatase (ALP) >250 U/L, gamma-glutamyl transferase (GGT) >11 U/L and total bilirubin >0.3 mg/dL and abdominal ultrasound alterations suggestive for a chronic biliary tree disease. Pre- and post-treatment serum samples were analysed using lipoprotein electrophoresis. Results showed significant reductions in serum cholesterol (median 293 mg/dL vs. 368 mg/dL) and triglycerides (median 70 mg/dL vs. 181 mg/dL). Lipoprotein analysis revealed a significant increase in HDL percentage (from 51 % to 62.9 %) and reductions in VLDL (from 33.2 % to 18 %) and chylomicrons (from 3.2 % to 1.7 %). These results suggest that fenofibrate is effective in reducing lipemia and improving lipid profiles in cholestatic dogs, helping to limit hepatic injury potentially associated with lipid accumulation.

Effect of Fenofibrate on Markers of Gut Barrier Function in Dogs With Naturally Occurring Diabetes Mellitus

BACKGROUND

Fenofibrate improves gut barrier function and reduces serum lipids in purpose-bred dogs with induced diabetes mellitus (DM), but its effects in dogs with naturally occurring DM are unknown.

OBJECTIVES

Determine the effects of fenofibrate on markers of systemic and pancreatic inflammation, markers of gut barrier function, lipoprotein profiles, and glycemic control in dogs with naturally occurring DM.

ANIMALS

Sixteen client-owned dogs with naturally occurring, uncomplicated DM.

METHODS

Longitudinal cohort study. Dogs were treated with fenofibrate (Tricor, 6-10 mg/kg, P.O., once daily) for 21 days. Interstitial glucose, serum cytokines, lipopolysaccharide (LPS), pancreatic lipase, and lipid profiles were compared between baseline and day 21 using paired t-tests and Wilcoxon signed-rank tests.

RESULTS

Fenofibrate had no effect on glycemic control, serum cytokines, or serum pancreatic lipase. Compared to baseline, the concentrations of serum LPS decreased at day 21 by (mean ± SD) 15 ± 24% (95% CI 2-28%, p = 0.03), serum triglycerides decreased by 36 ± 39% (95% CI 15-56%, p = 0.002), and serum cholesterol decreased by 20 ± 14% (95% CI 12-28%, p < 0.0001).

CONCLUSIONS AND CLINICAL IMPORTANCE

Fenofibrate treatment was not associated with a decrease in markers of systemic or pancreatic inflammation. In diabetic dogs, short-term fenofibrate treatment appears to be safe, and the improvement in gut barrier function and lipid profiles might lead to long-term benefits, such as reduction in pancreatitis risk and frequency of signs of gastrointestinal disease.

Sustained-Release Solid Dispersions of Fenofibrate for Simultaneous Enhancement of the Extent and Duration of Drug Exposure

BACKGROUND/OBJECTIVES

A sustained-release formulation of fenofibrate while enhancing drug dissolution with minimal food effect is critical for maximizing the therapeutic benefits of fenofibrate. Therefore, this study aimed to develop an effective solid dispersion formulation of fenofibrate for simultaneous enhancement in the extent and duration of drug exposure.

METHODS

Fenofibrate-loaded solid dispersions (FNSDs) were prepared using poloxamer 407 and Eudragit® RSPO at varied ratios via solvent evaporation. In vitro/in vivo characteristics of FNSDs were examined in comparison with untreated drugs.

RESULTS

Based on dissolution profiles of FNSDs in aqueous media, the weight ratio of fenofibrate: poloxamer 407: Eudragit® RSPO at 1:1:4 (FNSD2) was selected as the optimal composition for achieving sustained drug release while maximizing the drug dissolution. The enhanced and sustained drug release of FNSD2 was also confirmed in a buffer transition system mimicking the pH change in the gastrointestinal tract. FNSD2 achieved approximately 66% drug release over 12 h, while pure drug exhibited only 12%. Furthermore, FNSD2 maintained similar release rates under fed and fasted conditions, while the entire drug dissolution slightly increased in the fed state. Structural analysis by x-ray diffraction showed that fenofibrate remained crystalline in FNSD2. Pharmacokinetic studies in rats revealed that orally administered FNSD2 significantly improved the extent and duration of systemic drug exposure. Compared to pure drugs, the FNSD2 formulation increased the oral bioavailability of fenofibrate by 22 folds with the delayed Tmax of 4 h in rats.

CONCLUSION

FNSD2 formulation is effective in improving the extent and duration of drug exposure simultaneously.

Successful multimodal treatment of extreme hypertriglyceridemia in a juvenile diabetic dog

OBJECTIVE

To describe the therapeutic protocol used to normalize severe hypertriglyceridemia in a dog.

CASE SUMMARY

A 7-month-old, 1.2-kg female Pomeranian presented with acute polyuria, polydipsia, and ocular discoloration. Diagnoses included diabetic ketosis, severe hypertriglyceridemia (>225 mmol/L [>20,000 mg/dl]), lipemia retinalis, and bilateral uveitis. The triglyceride concentration was near normal within 2 days of initiating treatment with fenofibrate, regular insulin constant rate infusion (CRI), manual therapeutic plasma exchange (TPE), and a low-fat diet. All clinical signs resolved. The dog has had no relapse of hypertriglyceridemia at the time of writing the manuscript, 6 months later, with continued treatment of diabetes mellitus.

NEW OR UNIQUE INFORMATION PROVIDED

This is the first case report documenting the combination of fenofibrate, insulin CRI, and manual TPE for treatment of severe hyperlipidemia in a dog. Detailed protocols for manual TPE and a novel insulin CRI are provided. A discussion of multiple spurious biochemical and hematologic errors associated with the severe hypertriglyceridemia is also provided.

Therapy for feline secondary hypertriglyceridemia with fenofibrate

OBJECTIVES

The aim of this study was to assess the short-term safety and efficacy of fenofibrate in controlling secondary hypertriglyceridemia in cats.

METHODS

This was a prospective cohort study. Seventeen adult cats with hypertriglyceridemia (serum triglycerides [TG] >160 mg/dl) were enrolled. Cats received a median dose of 5 mg/kg (range 3.2-6) fenofibrate (q24h PO) for 1 month. Serum TG, total cholesterol (TC), creatine kinase and liver enzymes (alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase) were evaluated before (t0) and after 1 month (t1) of fenofibrate treatment.

RESULTS

The causes of secondary hypertriglyceridemia were diabetes mellitus (DM; 29.4%), obesity (29.4%), hyperadrenocorticism (HAC) and DM (11.7%), HAC without DM (5.9%), hypersomatotropism (HST) and DM (5.9%), hypothyroidism (5.9%), long-term treatment with glucocorticoids (5.9%) and chylothorax (5.9%). Serum TG (t0 median 920 mg/dl [range 237-1780]; t1 median 51 mg/dl [range 21-1001]; P = 0.0002) and TC (t0 median 278 mg/dl [range 103-502]; t1 median 156 mg/dl [range 66-244]; P = 0.0001) concentrations showed a significant decrease after 1 month of fenofibrate treatment. Fifteen cats normalized their TG concentration at t1 (88.2%). Of the eight cats that were hypercholesterolemic at t0, six (75%) normalized their TC concentrations at t1. One of 17 cats (5.9 %) presented with diarrhea; the remaining 16 did not show any adverse effects.

CONCLUSIONS AND RELEVANCE

DM and obesity are the most common endocrine causes of secondary hyperlipidemia, although it can also be found in cats with HAC, HST or hypothyroidism. This study suggests that fenofibrate treatment was associated with reduction and normalization of TG and TC concentrations in cats with moderate and severe hypertriglyceridemia, regardless of the cause of secondary hypertriglyceridemia. Further work should focus on controlled studies with a greater number of cases.

Efficacy of a micronized, nanocrystal fenofibrate formulation in treatment of hyperlipidemia in dogs

Background

Safe, effective, and readily available drug therapies are required for the management of hyperlipidemia and its associated complications in dogs.

Objectives

To investigate the efficacy of a micronized, nanocrystal formulation of fenofibrate (Tricor) in the treatment of hyperlipidemia in dogs.

Animals

Ten client‐owned dogs with primary (n = 7) and secondary (n = 3) hyperlipidemia. All dogs had hypertriglyceridemia at baseline; 3 dogs also had hypercholesterolemia.

Methods

Prospective dose‐escalation study. Dogs were treated with fenofibrate orally once daily in up to 3 cycles of 21 days each. Fenofibrate dose was increased at the end of each cycle if hypertriglyceridemia persisted and adverse effects were not documented. Complete blood count, biochemistry, and urine protein:creatinine ratio were collected serially. Baseline (T0) parameters were compared to time of maximal reduction in serum triglyceride concentrations (T1) and reported as median (range).

Results

Triglycerides normalized in all dogs (T0 = 662 mg/dL [189‐2391]; T1 = 113 mg/dL [81‐132]; P = .002). Fenofibrate dose at T1 = 6.4 mg/kg PO q24h (range, 2.2‐13.5). T1 was achieved at 3 (n = 4), 6 (n = 4), and 9 (n = 2) weeks. Serum cholesterol concentrations decreased in 9 of 10 dogs. Quiet demeanor and firm stools in 1 dog were the only reported adverse reactions. Fenofibrate administration resulted in a significant reduction in median alkaline phosphatase activity (P = .049).

Conclusions and Clinical Importance

Over 21 to 63 days, TriCor was effective in the management of primary and secondary hyperlipidemia in dogs.