Efficacy and safety of add on therapies in patients with hypercholesterolemia undergoing statin therapy

Brian Tomlinson, Paul Chan, Yuzhen Zhang, Christopher Wai Kei Lam

Research output: Contribution to journalReview articlepeer-review

8 Citations (Scopus)


Introduction: Statins are the first-line treatment to reduce cardiovascular (CV) events, mainly by reducing low-density-lipoprotein cholesterol (LDL-C), but many patients need additional treatments to reach the current lipid goals. Areas covered: Herein, the authors review the published literature on the efficacy and safety of the therapies that are most often added to statins to achieve lipid targets. Expert opinion: Ezetimibe is usually the first additional treatment to achieve LDL-C targets. It reduces LDL-C by about a further 20% and has an excellent safety and tolerability profile. The monoclonal antibody proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, evolocumab, and alirocumab, can reduce LDL-C by ≥50% when added to statins and they also have a well-established safety and tolerability record. The recently approved bempedoic acid is well tolerated and appears to be free of skeletal muscle-related problems, but the CV outcome study with this drug has not been completed. Inclisiran, a small-interfering RNA targeting PCSK9 is at an advanced stage of development and the available data indicate a satisfactory safety profile and LDL-C lowering efficacy similar to the PCSK9 monoclonal antibodies with the advantage of less frequent administration.

Original languageEnglish
Pages (from-to)2137-2151
Number of pages15
JournalExpert Opinion on Pharmacotherapy
Issue number17
Publication statusPublished - 2020


  • Alirocumab
  • bempedoic acid
  • evolocumab
  • ezetimibe
  • icosapent ethyl
  • inclisiran
  • proprotein convertase subtilisin/kexin type 9 inhibitors
  • statins

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)


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