Obicetrapib lowers Lp(a) by 37 percent (15 nmol/L) in high-risk patients: pooled analysis (Nicholls et al., EHJ 2026)

Background And Aims: There is interest in developing lipoprotein(a) [Lp(a)] lowering therapies. Cholesteryl ester transfer protein inhibitors lower Lp(a), however the effects of the selective inhibitor obicetrapib on Lp(a) levels in high cardiovascular risk patients have not been fully elucidated. This analysis investigated the effect of obicetrapib on Lp(a).

Methods: A pooled analysis of trials evaluating the 12-week lipid effects of daily obicetrapib 10 mg compared with placebo in patients with heterozygous familial hypercholesterolemia (HeFH) or atherosclerotic cardiovascular disease (ASCVD) investigated the effect of obicetrapib on Lp(a) levels.

Results: In 2356 patients, the pooled cohort had a median age of 66 years, 36% were female with a history of ASCVD in 82%, HeFH in 27% and statin use in 91%. Median baseline lipid levels included low-density lipoprotein cholesterol (LDL-C) of 92 mg/dL, apolipoprotein B (apoB) of 87 mg/dL and Lp(a) of 42.9 nmol/L. Obicetrapib produced placebo-adjusted reductions in LDL-C of 37.0% and 35 mg/dL, in apoB of 21.3% and 20 mg/dL, and in Lp(a) of 37.3% and 14.9 nmol/L. In patients with baseline Lp(a) levels ≥50-<150 nmol/L, obicetrapib produced placebo-adjusted reductions in Lp(a) of 43.3% and 36.3 nmol/L. While patients with baseline Lp(a) ≥150 nmol/L demonstrated a lower percentage reduction in Lp(a) with obicetrapib than those with baseline levels ≥50-<150 nmol/L, the absolute reduction in Lp(a) was similar in both groups (-32.3 vs -36.3 nmol/L).

Conclusions: Obicetrapib lowered LDL-C, apoB and Lp(a). The absolute reduction in Lp(a) with obicetrapib was similar in patients with mildly elevated Lp(a) levels, who are unlikely to qualify for administration of RNA-targeted Lp(a) lowering agents.