How to manage hypertriglyceridemia in patients taking Rizankuzimab?

From the Guidelines

To manage hypertriglyceridemia in patients taking Rizankuzimab, start with lifestyle modifications including a low-fat diet, regular exercise, weight loss if overweight, and alcohol restriction, as recommended by the American College of Cardiology 1. If triglyceride levels exceed 500 mg/dL despite lifestyle changes, consider adding pharmacotherapy such as fibrates (fenofibrate 145 mg daily), omega-3 fatty acids (2-4 g daily), or statins (such as atorvastatin 10-20 mg daily) 1. For severe hypertriglyceridemia (>1000 mg/dL), temporarily discontinue Rizankuzimab until levels normalize, as severe elevations increase pancreatitis risk 1. Some key points to consider in managing hypertriglyceridemia include:

• Regular monitoring of lipid profiles is essential, with baseline measurements before starting Rizankuzimab and follow-up testing every 3-6 months.
• Rizankuzimab, an IL-23 inhibitor used for psoriasis and other inflammatory conditions, can occasionally affect lipid metabolism through its impact on inflammatory pathways.
• Consultation with both a dermatologist and lipid specialist may be beneficial for optimizing treatment while managing triglyceride levels effectively.
• The treatment goal for patients with moderate hypertriglyceridemia is a non–high-density lipoprotein cholesterol level of 30 mg per dL (0.78 mmol per L) higher than the low-density lipoprotein goal, as recommended by the NCEP ATP III 1.
• Fibrates are the first-line treatment in patients with hypertriglyceridemia who are at risk of pancreatitis 1.
• Statins have a modest triglyceride-lowering effect (typically 10% to 15%) and may be useful to modify cardiovascular risk in patients with moderately elevated triglyceride levels 1.
• Physical activity, such as aerobic exercise, can help reduce triglyceride levels and improve overall cardiovascular health 1.
• A combination of physical activity and weight loss can result in up to a 20% reduction in triglycerides 1.

From the FDA Drug Label

The use of drugs should be considered only when reasonable attempts have been made to obtain satisfactory results with non-drug methods If the decision is made to use drugs, the patient should be instructed that this does not reduce the importance of adhering to diet Diseases contributory to hyperlipidemia, such as hypothyroidism or diabetes mellitus should be looked for and adequately treated. Estrogen therapy, thiazide diuretics and beta-blockers, are sometimes associated with massive rises in plasma triglycerides, especially in subjects with familial hypertriglyceridemia In such cases, discontinuation of the specific etiologic agent may obviate the need for specific drug therapy of hypertriglyceridemia.

There is no information about Rizankuzimab in the provided drug labels. The FDA drug label does not answer the question.

From the Research

Management of Hypertriglyceridemia

To manage hypertriglyceridemia in patients taking Rizankuzimab, several approaches can be considered:

• Lifestyle modifications, such as dietary changes and increased physical activity, are essential for lowering triglyceride levels 2, 3.
• For patients with high triglyceride levels, statins can be considered as the first line of therapy, especially for those with borderline or intermediate cardiovascular risk 3, 4.
• In patients with severely elevated triglyceride levels, fibrates, omega-3 fatty acids, or niacin may be added to reduce the risk of pancreatitis 3, 4.
• New therapeutic approaches, such as icosapent ethyl, pemafibrate, and inhibitors of ApoC-III and ANGPTL3, are being developed to address the unmet need for effective treatments for hypertriglyceridemia 5.

Treatment Options

The following treatment options can be considered for managing hypertriglyceridemia:

• Statins: effective in reducing triglyceride levels, especially in patients with high cardiovascular risk 4, 3.
• Fibrates: can lower triglyceride concentrations, but their efficacy in combination with statins has not been clearly shown in endpoint studies 2, 4.
• Omega-3 fatty acids: can lower triglyceride levels, and high-dose icosapent (purified eicosapentaenoic acid) has been shown to reduce cardiovascular mortality 3, 5.
• Niacin: can be considered for patients with severely elevated triglyceride levels, but its use is limited due to adverse effects 4, 3.

Special Considerations

In patients with acute pancreatitis associated with hypertriglyceridemia, insulin infusion and plasmapheresis should be considered if triglyceride levels remain high despite conservative management 3. Patients with purely genetic types of hypertriglyceridemia (familial chylomicronemia syndrome) should be treated in specialized outpatient clinics 2.