Efficacy and safety of add on therapies in patients with hypercholesterolemia undergoing statin therapy
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Published on: November 10, 2017
Brian Tomlinson1, Paul Chan2, Yuzhen Zhang3
1Faculty of Medicine, Macau University of Science and Technology , Macau, China.
Insights
Statins are first-line for cardiovascular events, but additional therapies like ezetimibe and PCSK9 inhibitors are often needed to reach lipid goals. These treatments offer significant low-density-lipoprotein cholesterol reduction with good safety profiles.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Lipid Management
Background:
- Statins are primary treatments for reducing cardiovascular events by lowering low-density-lipoprotein cholesterol (LDL-C).
- Many patients require additional therapies to achieve current LDL-C targets.
- Effective lipid management is crucial for cardiovascular risk reduction.
Purpose of the Study:
- To review the efficacy and safety of common add-on therapies to statins.
- To evaluate treatments used to achieve target lipid levels.
- To provide an expert opinion on current and emerging lipid-lowering strategies.
Main Methods:
- Literature review of published studies.
- Analysis of efficacy and safety data for add-on lipid-lowering therapies.
- Focus on treatments commonly combined with statins.
Main Results:
- Ezetimibe typically serves as the first add-on, providing an additional ~20% LDL-C reduction with good tolerability.
- PCSK9 inhibitors (evolocumab, alirocumab) achieve ≥50% LDL-C reduction with established safety.
- Bempedoic acid shows good tolerability, but CV outcome data is pending; Inclisiran demonstrates similar efficacy to PCSK9 inhibitors with less frequent dosing.
Conclusions:
- Ezetimibe and PCSK9 inhibitors are effective and safe options for patients not reaching LDL-C goals with statins alone.
- Emerging therapies like bempedoic acid and inclisiran offer additional choices with distinct profiles.
- Optimizing lipid-lowering therapy requires careful consideration of efficacy, safety, and patient-specific factors.
Introduction:
Statins are the first-line treatment to reduce cardiovascular (CV) events, mainly by reducing low-density-lipoprotein cholesterol (LDL-C), but many patients need additional treatments to reach the current lipid goals.
Areas Covered:
Herein, the authors review the published literature on the efficacy and safety of the therapies that are most often added to statins to achieve lipid targets.
Expert Opinion:
Ezetimibe is usually the first additional treatment to achieve LDL-C targets. It reduces LDL-C by about a further 20% and has an excellent safety and tolerability profile. The monoclonal antibody proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, evolocumab, and alirocumab, can reduce LDL-C by ≥50% when added to statins and they also have a well-established safety and tolerability record. The recently approved bempedoic acid is well tolerated and appears to be free of skeletal muscle-related problems, but the CV outcome study with this drug has not been completed. Inclisiran, a small-interfering RNA targeting PCSK9 is at an advanced stage of development and the available data indicate a satisfactory safety profile and LDL-C lowering efficacy similar to the PCSK9 monoclonal antibodies with the advantage of less frequent administration.
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