Add-on bempedoic acid may benefit patients with statin intolerance

Bempedoic acid may be a boon to patients with full statin intolerance, as its addition can lessen the need for proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and serve as a less expensive alternative to established oral lipid-lowering medications, according to a study.

In the study, researchers identified the target populations for bempedoic acid and PCSK9 inhibitors, as well as calculated the related treatment costs to achieve the low-density lipoprotein cholesterol (LDL-C) goal of <55 mg/dL and a ≥50 percent reduction assuming the addition of bempedoic acid to lipid-lowering medications.

The study population included 1,922 patients with coronary artery disease (CAD) from the observational cohort study INTERCATH. The researchers applied a Monte Carlo simulation to estimate the effect of adding sequentially a statin, ezetimibe, optional bempedoic acid, and a PCSK9 inhibitor on achievement of the LDL-C treatment goal. They simulated two scenarios for both a moderate (2 percent full and 10 percent partial) and a high (12 percent full) rate of statin intolerance: with and without bempedoic acid.

The mean age of the population was 69.3 years, and the median baseline LDL-C level was 86.0 mg/dL. The projected need for a PCSK9 inhibitor was 41.4 percent for a moderate rate of statin intolerance and 46.1 percent for a high rate of statin intolerance.

Adding bempedoic acid was estimated to lead to a reduction in the need for a PCSK9 inhibitor, between 25.3 percent and 29.4 percent. This, in turn, would lower the annual overall treatment cost incurred through PCSK9 inhibitor by 13.3 percent and 10.5 percent per 1 million patients with CAD, for a moderate and partial rate of statin intolerance, respectively. The strategy would also lower the cost per prevented event in the entire cohort (between –5.0 percent and –6.3 percent), although at the price of fewer prevented events (–8.7 percent and –4.5 percent).

Finally, the use of bempedoic acid was estimated to reduce the cost per prevented event (–6.8 percent for both rates of statin intolerance), with the number of prevented events greater in the subpopulation of patients with full statin intolerance.