Today’s big news in Lipid Land is that the first oral PCSK9 inhibitor was approved by the FDA! The generic name of this agent, which mechanistically is a macrocyclic peptide, is enlicitide, and I prefer to stick with that since the brand name sounds like what happens when someone gets a little carried away with their aesthetic lip filler treatment. And although there isn’t yet cardiovascular outcome trial data for enlicitide, the historic success of PCSK9 inhibition as a therapeutic approach bodes well for its utility.
And since enlicitide starts with “E,” you can remember it has roughly “Equal” LDL-C lowering compared to the PCSK9 inhibitor monoclonal antibodies and must be taken on an “Empty” stomach. A third E is that it “Eventually” it will be recognized by Insurance Companies sometime this decade…hopefully. Glaciers move faster than third party payors when it comes to approving new therapeutics.
The other available PCSK9 inhibitors are not orally administered, so this is the main distinguishing characteristic. Although let’s be honest: “Needle Phobia” is mostly a historic artifact at this point; the entire world WANTS to be on Ozempic, Mounjaro, testosterone replacement, “peptides,” and whatever else you apparently “need” to avoid dying this week. Prior Authorization Phobia Needle Phobia is mainly an excuse clinicians use when they don’t care enough about their eligible patients to prescribe a PCSK9 inhibitor.
If you want to read more about PCSK9 inhibition, you can check out Chapter 9 of THIS BOOK and THIS ARTICLE…oh, and THIS ARTICLE that I’ve written on the topic. But overall, I think a 4th E for “Exciting” is appropriate any time something that could help the right patient at the right time becomes available.
