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Review
. 2020 Jun 18;22(8):38.
doi: 10.1007/s11883-020-00858-4.

Lomitapide-a Microsomal Triglyceride Transfer Protein Inhibitor for Homozygous Familial Hypercholesterolemia

Claudia Stefanutti  1
Affiliations
Review

Lomitapide-a Microsomal Triglyceride Transfer Protein Inhibitor for Homozygous Familial Hypercholesterolemia

Claudia Stefanutti. Curr Atheroscler Rep. .

Erratum in

Abstract

Purpose of review: Homozygous familial hypercholesterolemia (HoFH) is a rare, genetic condition characterized by high levels of Low density lipoprotein cholesterol (LDL-C); overt, early-onset atherosclerotic cardiovascular disease (ASCVD); and premature cardiovascular events and mortality. Lomitapide is a first-in-class microsomal triglyceride transfer protein inhibitor for the treatment of HoFH. This review provides an update on data emerging from real-world studies of lomitapide following on from its pivotal phase 3 clinical trial in HoFH.

Recent findings: Recent registry data have confirmed that HoFH is characterized by delayed diagnosis, with many patients not receiving effective therapy until they are approaching the age when major adverse cardiovascular events may occur. Data from case series of varying sizes, and from a 163-patient registry of HoFH patients receiving lomitapide, have demonstrated that lomitapide doses are lower and adverse events less severe than in the phase 3 study. Lomitapide enables many patients to reach European Atherosclerosis Society LDL-C targets. Some patients are able to reduce frequency of lipoprotein apheresis or, in some cases, stop the procedure altogether-unless there is significant elevation of lipoprotein (a). Modelling analyses based on historical and clinical trial data indicate that lomitapide has the potential to improve cardiovascular outcomes and survival in HoFH. Real-world clinical experience with lomitapide has shown the drug to be effective with manageable, less marked adverse events than in formal clinical studies. Event modelling data suggest a survival benefit with lomitapide in HoFH.

Keywords: Cardiovascular disease; Drug therapy; Homozygous familial hypercholesterolemia; Lipoprotein apheresis; Lomitapide.

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Conflict of interest statement

Professor Stefanutti has no current, relevant conflicts of interest to report.

Figures

Fig. 1
Fig. 1
Data sources for lomitapide from clinical trials (red), registries (green), and case reports (blue)
Fig. 2
Fig. 2
Hepatic MRI for patient 3 in a 2015 and b 2018 (unpublished data)
Fig. 3
Fig. 3
Hepatic ultrasound for patient 5 in a 2014 and b 2019 (unpublished data)
See this image and copyright information in PMC

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