Real-world clinical experience demonstrates that lomitapide effectively lowers LDL-C in homozygous familial hypercholesterolemia with manageable adverse events at lower doses than in clinical trials.
Does lomitapide reduce LDL-C and improve cardiovascular outcomes in patients with homozygous familial hypercholesterolemia?
Real-world evidence confirms that lomitapide is an effective adjunct therapy for lowering LDL-C in HoFH, reducing the need for lipoprotein apheresis and potentially improving long-term survival, with a manageable safety profile.
PURPOSE OF REVIEW: Homozygous familial hypercholesterolemia (HoFH) is a rare, genetic condition characterized by high levels of Low density lipoprotein cholesterol (LDL-C); overt, early-onset atherosclerotic cardiovascular disease (ASCVD); and premature cardiovascular events and mortality. Lomitapide is a first-in-class microsomal triglyceride transfer protein inhibitor for the treatment of HoFH. This review provides an update on data emerging from real-world studies of lomitapide following on from its pivotal phase 3 clinical trial in HoFH. RECENT FINDINGS: Recent registry data have confirmed that HoFH is characterized by delayed diagnosis, with many patients not receiving effective therapy until they are approaching the age when major adverse cardiovascular events may occur. Data from case series of varying sizes, and from a 163-patient registry of HoFH patients receiving lomitapide, have demonstrated that lomitapide doses are lower and adverse events less severe than in the phase 3 study. Lomitapide enables many patients to reach European Atherosclerosis Society LDL-C targets. Some patients are able to reduce frequency of lipoprotein apheresis or, in some cases, stop the procedure altogether-unless there is significant elevation of lipoprotein (a). Modelling analyses based on historical and clinical trial data indicate that lomitapide has the potential to improve cardiovascular outcomes and survival in HoFH. Real-world clinical experience with lomitapide has shown the drug to be effective with manageable, less marked adverse events than in formal clinical studies. Event modelling data suggest a survival benefit with lomitapide in HoFH.
Claudia Stefanutti (Thu,) conducted a review in Homozygous Familial Hypercholesterolemia. Lomitapide was evaluated. Real-world clinical experience demonstrates that lomitapide effectively lowers LDL-C in homozygous familial hypercholesterolemia with manageable adverse events at lower doses than in clinical trials.