Bempedoic acid
chemical compound
Bempedoic acid, sold under the brand name Nexletol among others, is a medication for the treatment of hypercholesterolemia (high blood cholesterol levels).
The most common side effects include hyperuricemia (high blood levels of uric acid), pain in arms or legs, and anemia (low red blood cell counts).
Bempedoic acid blocks an enzyme in the liver called adenosine triphosphate-citrate lyase, which is involved in making cholesterol.
Bempedoic acid was approved for use in the United States in February 2020, and for use in the European Union in April 2020. The U.S. Food and Drug Administration considers it to be a first-in-class medication.
Medical uses
In the US, bempedoic acid is indicated for the treatment of hypercholesterolemia in combination with diet and the highest tolerated statin therapy in adults with heterozygous familial hypercholesterolemia, or with established atherosclerotic cardiovascular disease, who need additional lowering of LDL cholesterol.
In the EU, bempedoic acid is indicated in adults with primary hypercholesterolaemia (heterozygous familial and non familial) or mixed dyslipidaemia, as an adjunct to diet in combination with a statin or statin with other lipid-lowering therapies in patients unable to reach LDL-C goals with the maximum tolerated dose of a statin; or alone or in combination with other lipid-lowering therapies in patients who are statin intolerant, or for whom a statin is contraindicated.
Evidence for primary prevention is limited. A secondary analysis from the largest trial showed the potential for benefit in primary prevention; however, the number of individuals was small, and all participants were at high risk for ASCVD.
Side effects
Common adverse effects in clinical trials were muscle spasms (3.6% of treated patients, as compared to 2.3% under placebo), pain in the back (3.3% versus 2.2%) or in a limb (3.0% versus 1.7%), gout (1.5% versus 0.4%), and gastrointestinal problems such as diarrhea. A less common but more serious adverse effect was tendon rupture in the rotator cuff of the shoulder, the biceps tendon or the Achilles tendon (0.5% versus 0.0%).
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