Early investigational drugs targeting PPAR-α for the treatment of metabolic disease

Introduction: The fibrates have been used for many years to treat dyslipidemias and have also recently been shown to have anti-inflammatory effects. They are relatively weak PPAR-alpha agonists and do have some adverse effects. Novel compounds are in development, which are selective PPAR modulators (SPPARMs) and have more potent PPAR-alpha agonist activity. These may prove to have advantages in the treatment of dyslipidemia, insulin resistance and non-alcoholic fatty liver disease (NAFLD). Areas covered: This review focuses on PPAR-alpha agonists or SPPARMs in development describing the preclinical and early clinical studies. The information was obtained by searching the published literature and abstracts from recent meetings. Ongoing clinical trials were identified using the Clinicaltrial.gov database. Expert opinion: There is still a need for new drugs to treat atherogenic dyslipidemia. The highly potent and selective PPAR-alpha agonist K-877 has shown beneficial effects on atherogenic dyslipidemia and absence of some adverse effects seen with fibrates. The dual PPAR-alpha/PPAR-delta agonist GFT-505 has shown favorable results in improving atherogenic dyslipidemia and insulin resistance and appears to be a potential candidate for the treatment of NAFLD. Longterm trials are needed to assess the safety and efficacy of these new agents for cardiovascular and liver outcomes.