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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 4, July/August 2019

AFRICA

197

Glycation End Products (RAGE): a formidable force in the pathogenesis

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New, cheaper pill taken with statins lowers LDL cholesterol more

A small biotech company has a shot at shaking up a

market roosted by giants, moving towards approval with

a pill it believes can lower bad cholesterol at a discount to

other medicines, reports

Stat News

. According to Esperion

Therapeutics, a combination of its once-a-day treatment and

a maximum dose of statin lowered LDL cholesterol 18%

more than statins alone after 12 weeks.

The results come from the last of five successful trials

on Esperion’s drug, called bempedoic acid. The company

plans to submit all of its data to the US Food and Drug

Administration in the early months of 2019.

The report says the most important finding of the latest

bempedoic acid trial related to safety. In the 779-patient

study, Esperion’s drug was indistinguishable from placebo

when it came to side effects and deaths. That’s important

because, in an earlier trial involving more than 2 200 subjects,

more patients getting bempedoic acid died than those getting

placebo. The difference wasn’t big enough to rule out random

chance, and none of the deaths was blamed on the drug, but

it was enough to stoke concern that the FDA might think

twice about approving Esperion’s treatment.

‘From my perspective, I think the noise around those

imbalances should not be overestimated in importance,’ said

Dr Steven Nissen, a cardiologist at the Cleveland Clinic

who has served as unpaid investigator of bempedoic acid. ‘I

certainly don’t think it’s a regulatory issue at this point.’

The report says Esperion’s drug is meant for patients

who have had a cardiovascular event, like a heart attack or

a stroke, and who are getting as large a dose of statins as

they can handle. The drug is widely expected to win FDA

approval and hit the market in 2020, and that’s when the

company will find out whether its Goldilocks plan can turn

bempedoic acid into a commercial success.

As it stands, the vast majority of at-risk patients get

statins, which have long since gone generic and are available

for pennies a day for those with insurance. If bad LDL

cholesterol levels stay high, doctors prescribe the now-generic

Zetia. And in extreme cases, they reach for injected treatments

from Amgen and partners Regeneron Pharmaceuticals and

Sanofi, drugs that block a protein called PCSK9.

continued on page 215…