Simulation of bempedoic acid in the lipid-lowering treatment pathway using the European contemporary SANTORINI cohort of high- and very high-risk patients

Abstract Background Lowering LDL-C treatment goals in the 2019 ESC/EAS guidelines necessitates greater use of combination therapies (1). Cost PCSK9 inhibitors (PCSK9i) and efficacy ezetimibe alone as add on limit population level achievement goals. Purpose This simulation study assessed addition oral bempedoic acid (BA) to pathway a real-world cohort patients order assess proportion who might reach goal. Methods SANTORINI is European at high or very-high CV risk. Patients were receiving any known LLT regimen with available data baseline eligible for this analysis. For not risk-based goals, following algorithm was applied (Figure 1), first subsequently BA those statins, PCSK9i remained but no done. reductions associated based probabilistic distributions sourced from clinical trial efficacies prior studies (2–3). The effect levels simulated through Monte Carlo run 10,000 times. No statin intensification we assumed therapy maximum tolerated dose. Results At (N=6252), mean age 66 years 80.6 mg/dL 1444 (23%) goal; 93% (n=5797) very risk 7% (n=455) risk, whom 84% (n=5227) 23% (n=1447) 9% (n=546) PCSK9i. Out 4486 entering simulation, 3419 received add-on third predicted be achieving their goal (32%, n=1078/3419). Of goal, would result another 36% (n=1218/3408). Overall, number expected increase 2522 (40%) 3740 (60%) after BA, sequentially. whole fall 69.2 61.1 mg/dL, respectively. Conclusion Few few have use. Optimising statins could significantly more attaining lipid likely additional health benefits. Funding Acknowledgement Type funding sources: Private company. Main source(s): Daiichi Sankyo Europe GmbH