Dunaieva I. P., Kryvoshapka O. V., Pautina O. I., Doroshenko O. M., Shapoval O. M., Chorna N. S., Ruda N. G.
OBICETRAPIB AS A CHOLESTERYL ESTER TRANSFER PROTEIN INHIBITOR: A CLINICAL AND PHARMACOLOGICAL REVIEW AND PROSPECTS FOR USE (LITERATURE REVIEW)
Show/Download
About the author:
Dunaieva I. P., Kryvoshapka O. V., Pautina O. I., Doroshenko O. M., Shapoval O. M., Chorna N. S., Ruda N. G.
Heading:
LITERATURE REVIEWS
Type of article:
Scientific article
Annotation:
Cardiovascular diseases remain the leading cause of mortality worldwide, and dyslipidemia is one of the key factors in their development. Despite the availability of effective lipid-lowering agents, a substantial proportion of patients with high and very high cardiovascular risk fail to achieve target low-density lipoprotein (LDL) cholesterol levels, resulting in the persistence of residual risk. In this context, the search for new pharmacological targets re mains relevant. One promising approach is the inhibition of cholesteryl ester transfer protein (CETP), particularly through the use of obicetrapib, a next-generation selective CETP inhibitor. The aim of this study was to summarize and critically analyze current experimental and clinical data regarding the pharmacological properties of obicetrapib, its effects on the lipid profile, efficacy, and safety based on phase II III trials, as well as to determine its place in contemporary lipid-lowering therapy strategies. A systematic review of international scientific sources addressing the biological role of CETP, mechanisms of action of its inhibitors, and the clinical application of obicetrapib was conducted. Methods of analysis, synthesis, and generalization were employed to assess the drug’s effects on lipid metabolism parameters, as well as its efficacy and safety. In phase II-III clinical trials, obicetrapib demonstrated significant reductions in LDL, apolipoprotein B, and lipoprotein(a), along with an increase in high-density lipoprotein (HDL) cholesterol. In the BROADWAY and TANDEM studies, the drug was effective both as monotherapy and in combination with ezetimibe in high-risk patients. The safety profile remained favorable, with no adverse effects on blood pressure or hormonal parameters. Thus, obicetrapib may be considered a promising agent for intensive correction of dyslipidemia and reduction of residual cardiovascular risk.
Tags:
Bibliography:
- Fan J, Watanabe T. Atherosclerosis: Known and unknown. Pathol Int. 2022;72(3):151-160. DOI: 10.1111/pin.13202.
- Duarte Lau F, Giugliano RP. Lipoprotein(a) and its Significance in Cardiovascular Disease: A Review. JAMA Cardiol. 2022;7(7):760-769. DOI: 10.1001/jamacardio.2022.0987. Erratum in: JAMA Cardiol. 2022;7(7):776. DOI: 10.1001/jamacardio.2022.2074.
- Goldsborough E 3rd, Osuji N, Blaha MJ. Assessment of Cardiovascular Disease Risk: A 2022 Update. Endocrinol Metab Clin North Am. 2022;51(3):483-509. DOI: 10.1016/j.ecl.2022.02.005.
- Guijarro C, Cosín-Sales J. LDL cholesterol and atherosclerosis: The evidence. Clin Investig Arterioscler. 2021;33(1):25-32. DOI: 10.1016/j. arteri.2020.12.004.
- Boffa MB, Koschinsky ML. Lipoprotein(a) and cardiovascular disease. Biochem J. 2024;481(19):1277-1296. DOI: 10.1042/BCJ20240037.
- Lampsas S, Xenou M, Oikonomou E, Pantelidis P, Lysandrou A, Sarantos S, et al. Lipoprotein(a) in Atherosclerotic Diseases: From Patho physiology to Diagnosis and Treatment. Molecules. 2023;28(3):969. DOI: 10.3390/molecules 28030969.
- Mohammadpour AH, Akhlaghi F. Future of cholesteryl ester transfer protein (CETP) inhibitors: a pharmacological perspective. Clin Phar macokinet. 2013;52(8):615-26. DOI: 10.1007/s40262-013-0071-8.
- Rehman WU, Yarkoni M, Ilyas MA, Athar F, Javaid M, Ehsan M, et al. Cholesteryl Ester Transfer Protein Inhibitors and Cardiovascular Outcomes: A Systematic Review and Meta-Analysis. J Cardiovasc Dev Dis. 2024;11(5):152. DOI: 10.3390/jcdd11050152.
- Olmastroni E, Scotti S, Galimberti F, Xie S, Casula M. Ezetimibe: Integrating Established Use with New Evidence - A Comprehensive Review. Curr Atheroscler Rep. 2024;27(1):10. DOI: 10.1007/s11883-024-01248-w.
- Khan SU, Yedlapati SH, Lone AN, Hao Q, Guyatt G, Delvaux N, et al. PCSK9 inhibitors and ezetimibe with or without statin therapy for cardiovascular risk reduction: a systematic review and network meta-analysis. BMJ. 2022;377:e069116. DOI: 10.1136/bmj-2021-069116.
- Hummelgaard S, Vilstrup JP, Gustafsen C, Glerup S, Weyer K. Targeting PCSK9 to tackle cardiovascular disease. Pharmacol Ther. 2023;249:108480. DOI: 10.1016/j.pharmthera.2023.108480.
- Mehta N, Dangas K, Ditmarsch M, Rensen PCN, Dicklin MR, Kastelein JJP. The evolving role of cholesteryl ester transfer protein inhibition beyond cardiovascular disease. Pharmacol Res. 2023;197:106972. DOI: 10.1016/j.phrs. 2023.106972.
- Nicholls SJ, Ditmarsch M, Kastelein JJ, Rigby SP, Kling D, Curcio DL, et al. Lipid-lowering effects of the CETP inhibitor obicetrapib in combination with high-intensity statins: a randomised phase 2 trial. Nat Med. 2022;28(8):1672-1678. DOI: 10.1038/s41591-022-01936-7.
- Ogura M. Obicetrapib: There is still Life in the CETP Inhibitor! J Atheroscler Thromb. 2024;31(10):1367-1369. DOI: 10.5551/jat.ED265.
- Chang B, Laffin LJ, Sarraju A, Nissen SE. Obicetrapib Rebirth of CETP Inhibitors? Curr Atheroscler Rep. 2024;26(10):603-608. DOI: 10.1007/s11883-024-01231-5.
- Shinkai, Hisashi. Cholesteryl ester transfer-protein modulator and inhibitors and their potential for the treatment of cardiovascular diseas es. Vascular health and risk management. 2012;8:323-31. DOI: 10.2147/VHRM.S25238.
- Ready JM. Toward a Best-in-Class Inhibitor of Cholesteryl Ester Transfer Protein (CETP). J Med Chem. 2021;64(18):13212-13214. DOI: 10.1021/acs. jmedchem.1c01540.
- Dybiec J, Baran W, Dąbek B, Fularski P, Młynarska E, Radzioch E, et al. Advances in Treatment of Dyslipidemia. Int J Mol Sci. 2023;24(17):13288. DOI: 10.3390/ijms241713288.
- Hu W, Feng H, Liu Y, Xu X, Zhou P, Sun Z, et al. Recent advances in immunotherapy targeting CETP proteins for atherosclerosis preven tion. Hum Vaccin Immunother. 2025;21(1):2462466. DOI: 10.1080/21645515.2025.24624 66.
- Nicholls SJ, Nelson AJ. CETP Inhibitors: Should We Continue to Pursue This Pathway? Curr Atheroscler Rep. 2022;24(12):915-923. DOI: 10.1007/s11883-022-01070-2.
- Nicholls SJ, Ray KK, Nelson AJ, Kastelein JJP. Can we revive CETP inhibitors for the prevention of cardiovascular disease? Curr Opin Lipidol. 2022;33(6):319-325. DOI: 10.1097/MOL.0000000000000854.
- Deng S, Liu J, Niu C. HDL and Cholesterol Ester Transfer Protein (CETP). Adv Exp Med Biol. 2022;1377:13-26. DOI: 10.1007/978-981 19-1592-5_2.
- Marco-Benedí V, Cenarro A, Laclaustra M, Larrea-Sebal A, Jarauta E, Lamiquiz-Moneo I, et al. Lipoprotein(a) in hereditary hypercholesterolemia: Influence of the genetic cause, defective gene and type of mutation. Atherosclerosis. 2022;349:211-218. DOI: 10.1016/j.atherosclerosis.2021.08.009.
- Borén J, Packard CJ, Binder CJ. Apolipoprotein B-containing lipoproteins in atherogenesis. Nat Rev Cardiol. 2025;22(6):399-413. DOI: 10.1038/s41569-024-01111-0.
- Schmidt AF, Hunt NB, Gordillo-Marañón M, Charoen P, Drenos F, Kivimaki M, et al. Cholesteryl ester transfer protein (CETP) as a drug target for cardiovascular disease. Nat Commun. 2021;12(1):5640. DOI: 10.1038/s41467-021-25703-3.
- Taheri H, Filion KB, Windle SB, Reynier P, Eisenberg MJ. Cholesteryl Ester Transfer Protein Inhibitors and Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Cardiology. 2020;145(4):236-250. DOI: 10.1159/000505365.
- Brody JA, Sitlani CM, Psaty BM, Ye T, Ganz P, Floyd JS, Davies NM. Forecasting off-target drug toxicity using proteomic and genetic data: insights from Torcetrapib. medRxiv [Preprint]. 2025. DOI: 10.64898/2025.12.03. 25341213.
- McLain JH, Alsterda AJ, Arora RR. Cholesteryl Ester Transfer Protein Inhibitors: Trials and Tribulations. J Cardiovasc Pharmacol Ther. 2017;22(2):99-104. DOI: 10.1177/1074248416662349.
- Nurmohamed NS, Ditmarsch M, Kastelein JJP. Cholesteryl ester transfer protein inhibitors: from high-density lipoprotein cholesterol to low density lipoprotein cholesterol-lowering agents? Cardiovasc Res. 2022;118(14):2919-2931. DOI: 10.1093/cvr/cvab350.
- Tardif JC, Pfeffer MA, Dubé MP; dal-GenE Investigators. Pharmacogenetics-guided dalcetrapib therapy after an acute coronary syndrome. Eur Heart J. 2022;43(48):5062-5063. DOI: 10.1093/eurheartj/ehac644.
- Brodeur MR, Rhainds D, Charpentier D, Boulé M, Mihalache-Avram T, Mecteau M, et al. Dalcetrapib and anacetrapib increase apolipoprotein E-containing HDL in rabbits and humans. J Lipid Res. 2023;64(1):100316. DOI: 10.1016/j.jlr.2022.100316.
- Aidoud A, Guglieri M, Angoulvant D. Towards Precision Secondary Prevention: Pharmacogenetic Insights from the Dalcetrapib-ADCY9 Pathway. Eur J Prev Cardiol. 2025;2025:zwaf682. DOI: 10.1093/eurjpc/zwaf682.
- Bahbah EI, Shehata MSA, Alnahrawi SI, Sayed A, Menshawey A, Fisal A, et al. Safety and Efficacy of Evacetrapib in Patients with Inadequately-controlled Hypercholesterolemia and High Cardiovascular Risk; A meta-analysis of Randomised Placebo-controlled Trials. Prostaglandins Leukot Essent Fatty Acids. 2021;168:102282. DOI: 10.1016/j.plefa.2021.102282.
- Nelson AJ, Sniderman AD, Ditmarsch M, Dicklin MR, Nicholls SJ, Davidson MH, et al. Cholesteryl Ester Transfer Protein Inhibition Reduces Major Adverse Cardiovascular Events by Lowering Apolipoprotein B Levels. Int J Mol Sci. 2022;23(16):9417. DOI: 10.3390/ijms23169417.
- HPS3/TIMI55-REVEAL Collaborative Group, Writing Committee, Sammons E, Hopewell JC, Chen F, Stevens W, et al. Long-term safety and efficacy of anacetrapib in patients with atherosclerotic vascular disease. Eur Heart J. 2022;43(14):1416-1424. DOI: 10.1093/eurheartj/ ehab863.
- Ogura M. Obicetrapib: There is still Life in the CETP Inhibitor! J Atheroscler Thromb. 2024;31(10):1367-1369. DOI: 10.5551/jat. ED265.
- Lim GB. LDL-cholesterol lowering with obicetrapib. Nat Rev Cardiol. 2025;22(7):463. DOI: 10.1038/s41569-025-01173-8.
- Masson W, Barbagelata L, Lobo M, Nogueira JP, Handelsman Y. Lipid-lowering efficacy of obicetrapib: A comprehensive systematic review and meta-analysis. J Clin Lipidol. 2025;19(3):412-421. DOI: 10.1016/j.jacl.2024.12.016.
- Bittner V. Event Reduction With Obicetrapib: A Word of Caution. J Am Coll Cardiol. 2025;86(14):1059-1060. DOI: 10.1016/j.jacc.2025.08.031.
- Bhatti MI, Safiullah M, Farhan K, Ali A, Abdullah S, Ali A, et al. Obicetrapib and its impact on lipid parameters: A comprehensive meta analysis of the latest evidence. J Clin Lipidol. 2025;19(6):1536-1549. DOI: 10.1016/j.jacl.2025. 07.003.
- Krumholz HM, Pagidipati NJ. Obicetrapib and Cardiovascular Events: A Promising Signal in Need of Confirmation. J Am Coll Cardiol. 2025;86(14):1057-1058. DOI: 10.1016/j.jacc.2025.08.016.
- Cariou B, Moulin P. Obicetrapib and CETP inhibition: An exception to the rule? Med. 2025;6(8):100780. DOI: 10.1016/j.medj.2025.100780.
- Maalizadeh K, Parikh MA, Hunt CR, Frishman WH, Peterson SJ. Obicetrapib: A Novel Cholesterol Ester Transfer Protein Inhibitor. Cardiol Rev. 2025. DOI: 10.1097/CRD.0000000000001136.
- Lee SJ, Kim BK. Obicetrapib-ezetimibe combination therapy for patients with atherosclerotic cardiovascular disease. Lancet. 2025;405(10491):1720-1721. DOI: 10.1016/S0140-6736(25)00827-X.
- Averna M, Cefalù AB. LP(a): The new marker of high cardiovascular risk. Nutr Metab Cardiovasc Dis. 2025;35(3):103845. DOI: 10.1016/j. numecd.2024. 103845.
- Dunn A, Ditmarsch M, Kastelein JJP, Kling D, Neild A, Davidson MH, et al. Guiding Dyslipidemia Treatment: A Population Pharmacokinetic Pharmacodynamic Framework for Obicetrapib. J Clin Pharmacol. 2024;64(9):1150-1164. DOI: 10.1002/jcph.2448.
- Kastelein JJP, Hsieh A, Dicklin MR, Ditmarsch M, Davidson MH. Obicetrapib: Reversing the Tide of CETP Inhibitor Disappointments. Curr Atheroscler Rep. 2024;26(2):35-44. DOI: 10.1007/s11883-023-01184-1.
- Guo M, Liu Z. Safety and Efficacy of Obicetrapib in Patients at High Cardiovascular Risk. N Engl J Med. 2025;393(9):927-928. DOI: 10.1056/ NEJMc2510693.
- Kastelein JJP, Hsieh A, Dicklin MR, Ditmarsch M, Davidson MH. Obicetrapib: Reversing the Tide of CETP Inhibitor Disappointments. Curr Atheroscler Rep. 2024;26(2):35-44. DOI: 10.1007/s11883-023-01184-1.
- Sarraju A, Brennan D, Hayden K, Stronczek A, Goldberg AC, Michos ED, et al. Fixed-dose combination of obicetrapib and ezetimibe for LDL cholesterol reduction (TANDEM): a phase 3, randomised, double-blind, placebo-controlled trial. Lancet. 2025;405(10491):1757-1768. DOI: 10.1016/S0140-6736(25) 00721-4.
- Nicholls SJ, Nelson AJ, Ditmarsch M, Kastelein JJP, Ballantyne CM, Ray KK, et al. Obicetrapib on top of maximally tolerated lipid modifying therapies in participants with or at high risk for atherosclerotic cardiovascular disease: rationale and designs of BROADWAY and BROOKLYN. Am Heart J. 2024;274:32-45. DOI: 10.1016/j.ahj.2024.05.002.
Publication of the article:
«Bulletin of problems biology and medicine», 2026 Issue 1, 180, 61-72 pages, index UDC 615.272.4.03:616.1(048.8)