Bfw,

Aside from both being Phase 3 stage biotechs each with a single lead drug to reduce cardiovascular risk, there is very little overlap between ESPR and RVX. Apabetalone has little to no effect on LDL-C based on previous trials. Bempedoic acid, aside from documented anti-inflammatory effect of reducing hsCRP, has little to no overlap with the apabetalone modulated pathways. Someday in the future, patients may be prescribed co-treatment of apabetalone and bempedoic acid. There's room for both RVX and ESPR at the table.  

As you know, reducing LDL-cholesterol is just one of several CVD-risk reducing strategies. Revised recommendations aim to aggressively lower LDL-C to levels well below what statins can achieve alone. There are many ways to lower LDL-C, whether it is via already approved statins, ezetimibe, and PCSK9 antibodies, or combinations of these already approves therapies. Other alternative strategies in clinical development such as PCSK9 RNAi and bempedoic acid have the potential to expand the number of tricks in the toolbox. There is no one size fits all approach for aggressive lowering of LDL-C. Bempedoic acid (BA) is not just a potential mono-therapy for those who can't take statins. BA is also being developed as a combo therapy: BA+tolerable level of statin; BA+ezetimibe; BA+statin+ezetimibe; BA+PCSK9. Another trick in the toolbox to give patients and doctors more choices to arrive at their LDL-C target.

Looking into the post BETonMACE future, one challenge for Resverlogix and apabetalone will be expanding the patient population. BETonMACE only enrolled diabetic, low-HDL, recent history of ACS in 90 days. That is a sick population. Some of these diabetic, low-HDL, recent ACS patients in BETonMACE even have additional renal impairment. Does apabetalone have benefits on non-diabetics with low-HDL and high CVD risk? On diabetics with normal HDL and high CVD risk? On non-diabetics with normal HDL with high CVD risk? The LDL-C hypothesis is solidified and aggressive LDL-C lowering therapy is purused in pretty much all high CVD risk scenarios. Will apabetalone be clinically pursued for use in a wider patient population and not just diabetic, low-HDL? First step, get past BETonMACE with flying colors.

Bempedoic acid may flop or succeed. Apabetalone may flop or succeed. They both may flop. They both may succeed. One company may have a much higher upside than the other. One company may have followed a more tradition clinical development path than the other. Time will tell. But one doesn't have to be anti-company #2 if one is pro-company #1, or vice versa. They are not competitors. Both have clinical promise. Both have investment potential. I think the only reason ESPR gets brought up every once in a while on this RVX board is because they are in a similar development stage and some, including myself, like to point out the market cap valuation differences. I'm not giving investment advise on ESPR; I am only pointing out the clinical relevance of bempedoic acid.

BearDownAZ