Efficacy and outcomes of bempedoic acid versus placebo in patients with hypercholesterolemia: an updated systematic review and meta-analysis of randomized controlled trials

Introduction Bempedoic acid (BA) has shown varied efficacy in managing hyperlipidemia. We conducted the most extensive up-to-date meta-analysis, the first to include recent studies by Nissen et al., which boast the largest sample size. Methods Literature search was done on Medline, EMBASE, and Cochrane Library. The primary endpoint was a change in low-density lipoprotein-cholesterol (LDL-C) levels, while secondary endpoints encompassed changes in lipid parameters, clinical endpoints, and safety endpoints. The least-square mean (LSM) percent change was utilized for lipid changes, with statistical significance set at P < 0.05. Results This analysis included 12 randomized control trials with 22,249 participants. BA exhibited a substantial reduction in LDL-C levels LSM % change, −24.34; 95% confidence interval (CI), −27.80 to −20.88; P < 0.0001, total cholesterol levels (LSM % change, −16.62; 95% CI, −21.70 to −11.54; P < 0.00001) and high-density lipoprotein-cholesterol (HDL-C) levels (LSM % change, −4.22; 95% CI, −5.51 to −2.92; P < 0.00001) compared to the placebo. Conclusions BA significantly lowers LDL-C, total cholesterol, HDL-C, non-HDL-C, high sensitivity C reactive protein, and apolipoprotein levels.