Table 1.
Effects of established lipid-modifying agents on Lp(a)
| Drug or drug class | Effect on Lp(a) |
|---|---|
| Statins | Substantial heterogeneity between statin drugs in a meta-analysis of RCTs. Effects ranged from 13% reduction (95% CI 10–15%) for atorvastatin in the CARDS study82 to 15% increase (95% CI 13–17%) for simvastatin in the 4S study.131 No overall effect when data meta-analysed leading to uncertainty of the effect of statins.43 |
| Ezetimibe | No significant effect in a meta-analysis of RCTs.44 |
| Niacin | Reduced by 22.9% (95% CI 18.5–22.9%) in a meta-analysis of RCTs.132 Effect was not dose-dependent. |
| Fibrates | No significant effect in a meta-analysis of RCTs.133 |
| Bempedoic acid | No significant effect on Lp(a) in phase 2 study.134 |
| PCSK9 inhibitor monoclonal antibodies | Median Lp(a) reduction with evolocumab was 26.9% [interquartile range (IQR) 6.2–46.7%) in the FOURIER study.5 Median reduction with alirocumab was 25.6% (IQR 7.2–42.7%) in pooled phase 3 trial data.135 This was confirmed in a pooled analysis.45 |
| Inclisiran | 18.6% reduction from baseline in the phase 3 ORION-11 study.136 |
| Mipomersen | Median Lp(a) reduction in pooled phase 3 trials was 26.4% (IQR 5.4–42.8%).137 |
| CETP inhibitors | Evacetrapib reduced Lp(a) by up to 40% in a phase 2 study.76 Anacetrapib reduced Lp(a) by 34.1% in a small phase 2 study.138 |