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