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HelixTalk Episode #119 - What Is the Buzz about Bempedoic Acid for Dyslipidemia?

Date posted: September 22, 2020, 6:00 am

In this episode, we discuss the latest dyslipidemia treatment agent bempedoic acid and dive into its pharmacology, use, and clinical evidence.

 

Key Concepts

  1. Bempedoic acid (Nexletol) is an ACL (adenosine triphosphate-citrate lyase) inhibitor that works upstream on the same pathway as HMG-CoA reductase inhibitors ("statins") to reduce LDL cholesterol.
  2. Current evidence demonstrates that bempedoic acid decreases LDL levels by about 20% -- the reduction is closer to 15% in patients already on high intensity statins and closer to 25% with no or low-intensity statins.  Evidence for improvements in cardiovascular outcomes is not yet available; however, clinical trials are ongoing.
  3. Bempedoic acid is associated with an increased risk of gout attacks (via increased serum uric acid levels) and tendon rupture.  As with statins, bempedoic acid should not be used in women who are pregnant.
  4. Although bempedoic acid does not have hepatic CYP interactions, it does increase drug levels of certain medications via transporter-mediated drug interactions (OATs).  For example, do not exceed simvastatin 20 mg/day or pravastatin 40 mg/day in patients who are taking bempedoic acid. 

References

  • Goldberg AC, Leiter LA, Stroes ESG, et al. Effect of Bempedoic Acid vs Placebo Added to Maximally Tolerated Statins on Low-Density Lipoprotein Cholesterol in Patients at High Risk for Cardiovascular Disease: The CLEAR Wisdom Randomized Clinical Trial. JAMA. 2019;322(18):1780–1788. doi:10.1001/jama.2019.16585. https://jamanetwork.com/journals/jama/fullarticle/2754792
  • Ray KK. Bays HE. Catapano AL, et al. Safety and Efficacy of Bempedoic Acid to Reduce LDL Cholesterol. N Engl J Med 2019; 380:1022-1032. doi: 10.1056/NEJMoa1803917. https://www.nejm.org/doi/full/10.1056/NEJMoa1803917
  • Banach M, Duell PB, Gotto AM, et al. Association of Bempedoic Acid Administration With Atherogenic Lipid Levels in Phase 3 Randomized Clinical Trials of Patients With Hypercholesterolemia. JAMA Cardiol. Published online July 01, 2020. doi:10.1001/jamacardio.2020.2314