Esperion scores FDA nod for cholesterol-buster Nexletol

Doctor putting stethescope to patient's chest
Esperion's Nexletol scored its FDA nod despite prior safety concerns nearly derailing the drug's quest. (Pixabay)

Esperion has had a rocky road to approval for its LDL-cholesterol-lowering drug Nexletol after a late-stage trial in 2018 threatened to derail its quest. But after backing its drug up with strong safety data, Esperion has the green light to go to market. 

The FDA on Friday approved Esperion's Nexletol (bempedoic acid) to lower LDL cholesterol in patients with abnormally high cholesterol or established atherosclerotic cardiovascular disease who have reached maximum-tolerated statin therapy, the company said.

The orally administered, once-daily drug will be commercially available March 30, Esperion said in a release, at the "lowest branded tier coverage for Medicare patients" and at a cost as low as $10 for a three-month supply for eligible patients.

In January, Esperion Chief Commercial Officer Mark Glickman said the company was aiming for both Nexletol and another Esperion cholesterol drug awaiting approval––a bempedoic acid-ezetimibe combo––to hit the market at prices far below its competitors in the space.

“The biggest mistake that pharma companies made over the last several years is they asked managed care what would be a good price … and then ignored them,” Glickman said at the annual J.P. Morgan Healthcare Conference in January. “I promise you, nobody told Sanofi and Regeneron that $14,000 was a good price for a PCSK9.” 

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On Monday, Glickman told analysts that Esperion was in the process of finalizing offers for around 300 territory managers and 25 directors to support its marketing effort to target nearly 36,000 healthcare professionals in the early stages of Nexletol's launch. The drugmaker also plans to hire on additional managers if it reaches future uptake and market share milestones, he said. 

Field managers have been on the ground since July, giving Nexletol a running head start for launch, Esperion CEO Tim Mayleben added.

"I would say the awareness has increased significantly over the last seven or eight months," Mayleben told analysts. "We’re on a really nice trajectory."

The FDA based its approval on data from the Nexletol clinical program, including four late-stage trials showing the drug topped placebo by 18% in reducing LDL-C in patients treated with moderate- or high-intensity statins. Nexletol was approved for patients who have reached their maximum statin tolerance, the company said. 

Top-line data from one of those studies, released in May 2018, showed Nexletol lowered LDL-C levels by an additional 20% over 12 weeks in high-risk patients taking statins––but a rash of deaths in the treatment arm caused a momentary panic for investors. 

The company’s initial press release categorized the adverse events as unrelated to the treatment, with deaths listed in a separate chart, but did not offer an immediate explanation. On a later conference call with investors, Esperion’s senior vice president for clinical research, Bill Sasiela, said the deaths stemmed from an older, less-healthy study population, two-thirds of whom were current or former smokers.

RELATED: Safety update sets up filings for Esperion cholesterol drug

In October of that year, Esperion followed that assurance up with 52-week safety data that "showed no clinically relevant differences between the bempedoic acid and placebo groups” when it came to adverse events, serious adverse events, discontinuations or fatalities, with the latter seen in 1.1% and 0.8% of patients, respectively.

Jefferies analysts said at the time that numerous experts “said repeatedly that the imbalances in the first phase 3 study were noise/random and don't think they were a problem.”

The FDA approved Nexletol with no death warnings on its label, but the label does include risks of gout and tendon rupture. 

Esperion is also awaiting an FDA decision on its bempedoic acid-ezetimibe combo, which is currently under regulatory review and scored a win in a phase 2 trial in August. In that study, the combination reduced levels of LDL cholesterol by 40% over placebo, hitting a co-primary endpoint. Patients treated with the combo also showed “no worsening of glycemic control” over those treated with placebo. 

Editor's Note: This story has been updated to include comments from a Monday morning management call with analysts.