bempedoic acid

[bedrock]

How often do you all use Nexletol or Nexlizet in your practice?

Is it just patients with familial hypercholesterolemia or do you use it with some regularity for patients who can't lower their LDL sufficiently with a statin?

This is not a personal medical question, but I am trying to get an idea of how often this drug is used in private practice

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[aafisahar]

dumb drug indicated for a dumb reason

trial was lukewarm at best

Not worth 10 bucks a month never mind 500

 

[bedrock]

dumb drug indicated for a dumb reason

trial was lukewarm at best

Not worth 10 bucks a month never mind 500

Thanks for your thoughts.

Another question though. Would it not have some utility in a patient with higher than desired LDL on max statin dose, for those patients reluctant to consider regular injections?

Or for patients with statin myopathy? As bempedoic acid is converted to an active form in liver , not muscles like a statin.

 

[bedrock]

Seems like reasonable data in their most recent study.

 

[aafisahar]

Thanks for your thoughts.

Another question though. Would it not have some utility in a patient with higher than desired LDL on max statin dose, for those patients reluctant to consider regular injections?

Or for patients with statin myopathy? As bempedoic acid is converted to an active form in liver , not muscles like a statin.

Never been studied in a statin background therapy, so effect may be dubious at best. CLEAR enrolled patients who didn't want a statin. I'm not a big believer in LDL goals either since a bunch of drugs that lower LDL don't actually translate into clinical outcomes (cholestyramine, Zetia, niacin, fibrates). I bet that if you do the right RCT in a statin background with bempedoic acid, the lukewarm trial results melt away.

IMO, LDL goals are a push by industry to sell PCSK9i with mostly impotent data in most patients. Also PCSK9i has not been tested in a statin negative background, so their use in statin intolerant patients is hypothesis generating only.

In general, not a huge fan of prescribing medicines for the sake of prescribing. All these meta-analysis showing LDL benefit are just data laundering. One good RCT is worth more than 25 garbage retrospective studies. The best data is in secondary prevention with a statin, LDL goals be damned.

Finally, FH patients should not be generalized as a whole either. That's an entirely different pathophysiology that shares a biomarker that we are interested in. Moreover, it's been a bit since I reviewed the data, but even in these patients, the best data is high intensity statin as first line therapy.