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This study summarizes safety data for fibrates when used for treatment of cholestatic liver diseases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic review of published studies evaluating the use of fibrates for treatment of primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) was performed. Electronic databases were searched up to December 2019 for published studies evaluating treatment outcomes associated to fibrates for these 2 diseases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 37 studies were identified, including 31 for PBC and 6 for PSC, with a total of 1107 unique patients treated with fibrates\u00a0\u00b1\u00a0ursodeoxycholic acid (UDCA). Most studies evaluated fenofibrate and bezafibrate, and only 1 study evaluated pemafibrate. There were no studies evaluating gemfibrozil or clofibrate. The most commonly reported adverse events (AEs) were gastrointestinal and musculoskeletal. Elevations of aminotransferases and serum creatinine were reported more commonly in patients treated with UDCA plus fibrates versus UDCA monotherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Fibrates appear to be safe and well tolerated in patients with PBC, with a low frequency of AEs. There are scarce data about the safety of these agents for treatment of PSC.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.14871","type":"journal-article","created":{"date-parts":[[2021,3,10]],"date-time":"2021-03-10T06:59:22Z","timestamp":1615359562000},"page":"1335-1343","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":56,"title":["Safety of fibrates in cholestatic liver diseases"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5805-6638","authenticated-orcid":false,"given":"Andres F.","family":"Carrion","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of Miami Miami FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1046-5621","authenticated-orcid":false,"given":"Keith D.","family":"Lindor","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic 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