“The ongoing bempedoic acid CVOT trial will: 1) have average dosing of ~3.75 years; 2) have 12,600 patients with, or at high-risk for, cardiovascular disease; 3) use 5-point MACE as endpoint; 4) aim for ~1400 MACE events; 5) powered to detect a 14% RRR. A 14-20% RRR would be on par with the RRR achieved by other recent LDL-C lowering CVOT trials, as well as the RRR acheived by SGLT2 inhibitors, GLP1-R agonists and anti-IL1B canakinumab therapy.”

4S - 30% RRR mortality 

HPS - 24% RRR major vascular events

TNT - 22% RRR major CV event

These are landmark studies that solidified the use of statins. 

Canakinumab - sales for CV indications?

The other agents are targeted to diabetics so not directly comparable to bempedoic acid’s target population.

If they come in at 14% RRR and you have to take the drug for 3.75 years....that will be a disappointment.

The drug will end up only being prescribed for statin intolerant patients. In reality, most can tolerate statins and can be switched to lower doses or every other day dosing if necessary.

Bempedoic acid is no statin and I submit it will be inferior for MACE reduction than Apabetalone.

Esperion is aiming for a low bar and it will be a while before we even know if they hit it.

There is a reason BETONMACE is looking for 25-30% RRR.

ESPR market cap 1.3 Billion US

RVX market cap around $400 million US

I think I know where I’ll keep my investment funds.

bfw