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Published on: November 10, 2017
Efficacy and safety of add on therapies in patients with hypercholesterolemia undergoing statin therapy
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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