Esperion announced publication of updated recommendations from the ILEP which advance bempedoic acid utilization in front of injectable PCSK9 inhibitors. The article, entitled "Bempedoic acid in the management of lipid disorders and cardiovascular risk. 2023 position paper of the international lipid expert panel" was published in Progress in Cardiovascular Disease. In 2022, the ILEP published recommendations on management of partial or complete statin intolerant patients, utilizing both ezetimibe and PCSK9i therapy ahead of bempedoic acid. Based on the robustness of the CLEAR Outcomes results, the ILEP now recommends bempedoic acid utilization ahead of PSCK9i therapy, either in combination or after ezetimibe treatment. Highlights from the ILEP recommended pathways on the use of bempedoic acid in patients with very high cardiovascular risk are summarized below: Key ILEP Recommendations in Secondary Prevention Patients: In ASCVD/HeFH patients with baseline LDL-C 110-160 mg/dl, utilize an upfront combination of high intensity statin and ezetimibe, and if LDL-C is still greater than 55 mg/dl, start with bempedoic acid. If patient LDL-C is still greater than 55 mg/dl start with PCSK9i targeted therapy, if available. In ASCVD/HeFH patients with baseline LDL-C greater than160 mg/dl, utilize an upfront combination of high intensity statin and fixed dose combination of bempedoic acid and ezetimibe, and if LDL-C is still greater than 55 mg/dl, start with PCSK9i targeted therapy, if available. Key ILEP Recommendations in Primary Prevention Patients: In very high-risk patients with partial statin intolerance, utilize an upfront combination of high intensity statin and ezetimibe, and if LDL-C is still greater than 55 mg/dl, start with bempedoic acid. If patient LDL-C is still greater than 55 mg/dl start with PCSK9i targeted therapy, if available. In very high-risk patients with complete statin intolerance, utilize an upfront combination of bempedoic acid and ezetimibe, and if LDL-C is still greater than 55 mg/dl, start with PCSK9i targeted therapy, if available.
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