BackgroundThis retrospective, multicenter study evaluated the effect of pemafibrate treatment on liver function and fibrosis by liver function tests (LFTs) and various fibrotic biomarkers including FibroScan in non-alcoholic fatty liver disease (NAFLD) with hypertriglyceridemia.MethodsA total of 138 NAFLD patients treated with pemafibrate at three hospitals between September 2018 and April 2021 were included. To evaluate the effect of pemafibrate treatment, FibroScan-aspartate aminotransferase (FAST) score, a novel index of steatohepatitis that can be calculated based on the aspartate aminotransferase (AST) value, controlled attenuation parameter (CAP), and liver stiffness measurement (LSM) was used.ResultsSerum TG levels were significantly decreased 4 weeks after pemafibrate treatment (p= 0.003). The levels of AST (p= 0.038), alanine aminotransferase (ALT) (p= 0.003), and gamma-glutamyl transferase (GGT) (p= 0.047) also significantly diminished 12 weeks after pemafibrate administration compared to before administration (p< 0.05). However, serum HDL-cholesterol (p= 0.193), LDL-cholesterol (p= 0.967), and eGFR (p= 0.909) levels were not significantly altered 12 weeks after pemafibrate administration. In addition, the fibrosis biomarkers’ Type IV collagen (p= 0.753) and FIB-4 index (p= 0.333) did not significantly differ, while Autotaxin (p= 0.006) and the AST-to-platelet ratio index (APRI) (p= 0.003) significantly decreased 48 weeks after pemafibrate administration. No significant reductions in LSM (p= 0.959) and CAP (p= 0.266) were detected using FibroScan 48 weeks after pemafibrate administration. FAST score was significantly improved (p= 0.0475).ConclusionPemafibrate improved LFTs, including fibrotic biomarkers and FAST score, due to the hepatic anti-inflammatory effect, suggesting that pemafibrate may prevent disease progression in NAFLD patients with hypertriglyceridemia.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12072-022-10453-1.