From the Guidelines
Icosapent ethyl should be prescribed at a dosage of 4 g/day to patients with moderately elevated triglycerides (135–499 mg/dL) who have established cardiovascular disease or diabetes plus at least one other cardiovascular risk factor, as it has been shown to reduce the risk of cardiovascular events by 25%. This recommendation is based on the results of the Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial (REDUCE-IT) 1, which demonstrated a significant reduction in cardiovascular events, including cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke. The trial enrolled 8,179 adults receiving statin therapy and found that icosapent ethyl reduced the composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke by 26% 1.
Key points to consider when prescribing icosapent ethyl include:
- The patient's triglyceride levels, which should be between 135–499 mg/dL
- The presence of established cardiovascular disease or diabetes with at least one other cardiovascular risk factor
- The importance of continuing to take other prescribed cardiovascular medications alongside icosapent ethyl
- The potential side effects, including joint pain, swelling, and increased bleeding risk, which should be monitored carefully, especially in patients on blood thinners 1.
It is essential to note that the results of the REDUCE-IT trial should not be extrapolated to other n-3 fatty acids, as the trial only investigated the effects of icosapent ethyl 1. Additionally, lifestyle interventions, treatment of secondary factors, and avoidance of medications that might raise triglycerides are also recommended for patients with moderate hypertriglyceridemia 1.
From the FDA Drug Label
INDICATIONS AND USAGE Icosapent ethyl capsules are an ethyl ester of eicosapentaenoic acid (EPA) indicated: as an adjunct to diet to reduce TG levels in adultpatients with severe (≥ 500 mg/dL) hypertriglyceridemia. The primary use of icosapent ethyl is to reduce triglyceride (TG) levels in adults with severe hypertriglyceridemia (≥ 500 mg/dL) as an adjunct to diet 2. Key points about icosapent ethyl include:
- Indication: reduction of TG levels in adult patients with severe hypertriglyceridemia
- Limitation of use: the effect on the risk for pancreatitis in patients with severe hypertriglyceridemia has not been determined 3
From the Research
Icosapent Ethyl Overview
- Icosapent ethyl is a high-purity ethyl ester of eicosapentaenoic acid (EPA) used to treat severe hypertriglyceridemia 4, 5.
- It is de-esterified to EPA following oral administration and contains ≥96% of the EPA ethyl ester, without docosahexaenoic acid (DHA) 4.
Mechanism of Action and Effects
- Icosapent ethyl lowers triglyceride (TG) levels by 33.1% without increasing low-density lipoprotein cholesterol (LDL-C) levels 4.
- It has favorable effects on other lipid parameters and a tolerability profile similar to that of placebo 4.
- Icosapent ethyl is effective in reducing cardiovascular events in adults with elevated triglycerides 6, 7.
Clinical Uses and Recommendations
- Icosapent ethyl is approved for use as an adjunct to diet to lower TG levels in adult patients with severe (≥500 mg/dL) hypertriglyceridemia 4, 5.
- It is also indicated for patients at high cardiovascular risk who have fasting or non-fasting triglyceride levels ≥150 mg/dL despite maximally tolerated statin treatment 6.
- Current guidelines recommend icosapent ethyl for the treatment of hypertriglyceridemia and alleviating cardiovascular risk 6, 7.
Comparison with Other Treatments
- Icosapent ethyl offers a new alternative with potential benefits over currently available treatments for dyslipidemia, such as omega-3 fatty acid products containing both EPA and DHA 5.
- Omega-3 fatty acid preparations containing a combination of EPA and DHA are not indicated for reduction of cardiovascular risk and should be actively deprescribed 6.