Pharmacists are gaining access to a new generation of lipid-lowering therapies that could reshape how they manage patients with stubborn cholesterol and triglyceride levels. Jeremy L. Johnson, a professor of pharmacy practice at Southwestern Oklahoma State University, recently outlined the expanding options in an interview, emphasizing that statins remain the foundation while newer agents fill critical gaps for patients who cannot hit stricter targets.
Oral and Injectable PCSK9 Inhibitors Enter the Market
The most significant development involves PCSK9 inhibitors. For years, pharmacists knew these only as injectable monoclonal antibodies dosed every two weeks. Two newer options now offer different convenience profiles. Lerodalcibep (Lerochol) requires just one monthly injection and achieves 50% to 62% LDL reduction. Inclisiran (Leqvio), available for a few years now, is given every six months after initial doses, also delivering roughly 50% LDL lowering.
The setting shifted further with the July 2026 approval of enlicitide (Lipfendra), the first oral PCSK9 inhibitor. Johnson noted that daily oral dosing can produce up to 65% LDL reduction. A second oral agent called laroprovstat remains under investigation but shows comparable efficacy in early trials. These options matter because adherence often improves when patients can avoid frequent injections.
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Lipoprotein(a) Screening Now Recommended for All Adults
Johnson highlighted a major change in the newest ACC/AHA lipid guidelines: every adult should now be screened for lipoprotein(a) levels. This marker operates independently from LDL and contributes to atherosclerosis risk. Unlike cholesterol, lipoprotein(a) appears driven largely by genetics rather than lifestyle factors.
Several potent agents are advancing through development. Olpasiran, zerlasiran, and lepodisiran—all injectable—have demonstrated greater than 95% reductions in early trials, with potential dosing intervals of two to six months. Pelacarsen, another injectable, achieves similar lipoprotein(a) lowering.
Johnson stressed a key limitation: cardiovascular outcomes data remain years away for these agents. Demonstrating that lowering lipoprotein(a) actually prevents heart attacks, strokes, or cardiovascular death requires lengthy follow-up after initial efficacy studies.
Stronger Options for Severe …
Patients facing dangerous triglyceride elevations now have therapies far more powerful than older agents. Olezarsen (Tryngolza) and plozasiran (Redemplo) can lower triglycerides by 60% to 80%, compared to the 10% to 30% range achieved by previous medications. Both are injectable agents dosed monthly or every three months.
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These drugs target the most severe cases first. Both received approval for familial chylomicronemia syndrome, a rare condition causing extreme triglyceride buildup. Olezarsen also carries an indication for hypertriglyceridemia above 500 mg/dL, giving it broader potential use alongside traditional therapies.
Counseling Points for the Pharmacy Counter
Johnson outlined practical considerations pharmacists should cover with patients starting these newer therapies. Efficacy monitoring remains essential, though trial data show these agents are generally well tolerated. Injection-site reactions occur but have not been significant concerns so far.
Device familiarity matters considerably. Some formulations come as auto-injectors while others use prefilled syringes. Storage requirements vary: certain medications need refrigeration, while others can remain at room temperature for up to 90 days. Johnson emphasized that pharmacists should ensure patients understand both the administration technique for their specific device and how to store it properly.
