Anacetrapib
Update on novel lipid drugs: anacetrapib cut coronary events by 7% but not wider CVD outcomes, leaving CETP inhibitors without further development (Curr Opin Cardiol 2018)
Original title: An update on trials of novel lipid-lowering drugs
A review of recent trials of novel lipid-lowering therapies notes that PCSK9 inhibitors reduce LDL-C by 50 to 55%, with an outcomes trial of evolocumab in acute coronary syndrome patients reaching an LDL-C of 0.8 mmol/L (31 mg/dL) and a 20% relative risk reduction in cardiovascular events over 2.2 years. CETP inhibitors raise HDL-C and can lower LDL-C; anacetrapib reduced coronary artery disease events by 7%, but not wider composite cardiovascular outcomes, in a chronic cardiovascular disease population with a pretreatment LDL-C of 1.6 mmol/L (62 mg/dL). The author states the conflicting outcomes across CETP inhibitor trials mean these compounds are not being developed further. The review also notes canakinumab, an interleukin-1B receptor antagonist, validated inflammation as an atherosclerosis target by reducing acute coronary interventions, at the cost of increased infections.
Original abstract
Purpose Of Review: A number of novel trials have assessed the efficacy of new lipid-lowering therapies in cardiovascular disease (CVD).
Recent Findings: Proprotein convertase subtilisin kexin-9 inhibitors reduce low-density lipoprotein cholesterol (LDL-C) by 50-55%. A CVD outcome trial in patients with acute coronary syndromes with evolocumab achieved a LDL-C of 0.8 mmol/l (31 mg/dl) and a 20% relative risk reduction in CVD events in 2.2 years. Cholesterol ester transfer protein inhibitors raise high-density lipoprotein cholesterol and can lower LDL-C. Anacetrapib reduced coronary artery disease events by 7%, but not wider composite CVD outcomes, in a population with chronic CVD with pretreatment LDL-C of 1.6 mmol/l (62 mg/dl). The conflicting outcomes of cholesterol ester transfer protein inhibitor trials means these compounds are not being developed further. Trials using lipid drugs targeting inflammation have previously been generally unsuccessful, but recent data on the interleukin-1B receptor antagonist canakinumab has proven the concept of intervention on inflammation in atherosclerosis by showing a reduction in acute coronary interventions, but at the predictable cost of increased infections.
Summary: Despite the success of proprotein convertase subtilisin kexin-9 inhibition, the ability to achieve low LDL-C with off-patent medications and the costs of novel therapies will limit their use even in high-risk patients and confine them to the highest-risk sub-groups of patients.
Summary written by cetpinhibition.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.