A bempedoic acid/ezetimibe combination pill packed an extra punch for low-density lipoprotein (LDL) cholesterol reduction in patients already on maximally-tolerated statins, according to .
Individuals who were randomized to the combo pill -- with 180 mg bempedoic acid and 10 mg ezetimibe -- showed LDL reduction of 32% at 12 weeks in the 382-patient phase III trial, compared with the following:
- Placebo (3%, P<0.001)
- Ezetimibe 10 mg alone (24%, P<0.001)
- Bempedoic acid 180 mg alone (20%, P<0.001)
In those considered statin-intolerant, a post hoc analysis suggested that the combination pill reduced LDL cholesterol by 43%, versus 1% with placebo, Esperion said.
"Combination ezetimibe/bempedoic acid will be most useful in high-risk, statin-intolerant patients who will get the largest reduction in LDL cholesterol, which is what drives cardiovascular disease event reduction, not titration to an LDL cholesterol goal <70 mg/dl," predicted Jennifer Robinson, MD, MPH, of the University of Iowa in Iowa City, who was not involved in the trial.
"We anticipate the with bempedoic acid [without ezetimibe] will have a similar reduction in the relative reduction in the risk of nonfatal and fatal cardiovascular events proportional to LDL cholesterol lowering as observed in the statin trials," Robinson told 51˶.
When it came to serious adverse events and drug discontinuations due to adverse events, the combination pill ran in the middle of the pack.
Besides a decrease in LDL, bempedoic acid/ezetimibe was associated with a 34% drop in high-sensitivity C-reactive protein.
Esperion said it expects top-line results from a with the bempedoic acid/ezetimibe combo in October, with marketing applications filed in early 2019. Esperion was careful to note that it had negotiated a "regulatory pathway" for the combination product with the FDA -- which had not been the case when the company submitted bempedoic acid monotherapy for approval, leading to the FDA's 11th-hour demand in 2016 for the cardiovascular outcomes trial. That is not expected to finish until 2022.