Pharmaceutical giant Eli Lilly is developing a groundbreaking drug that could revolutionize heart disease treatment for millions of South Asians, including Indians who face disproportionately high cardiovascular risks. The experimental drug, lepodisiran, has shown remarkable efficacy in reducing lipoprotein(a) levels—a genetically inherited risk factor for heart disease—by up to 95% after a single 400mg dose in midstage clinical trials.
David Ricks, CEO of Eli Lilly, told The Economic Times that the drug can potentially cut lipoprotein(a) (LPA) cholesterol by 85-90%, addressing a specific type of cholesterol that is highly prevalent in South Asian populations. "Lilly is pursuing an important target for Indians. It is about lowering the LPA cholesterol particles. Despite the success of statins and other commonly used cholesterol-lowering medications, one particle that is toxic but is not addressed yet is LPA," Ricks explained.
A Critical Intervention for South Asian Populations
Scientific studies indicate that approximately 25% of South Asians have elevated LPA levels, significantly higher than other populations globally. This genetic predisposition contributes to the alarming cardiovascular disease statistics in the region. According to the World Heart Federation, an estimated 64 million Indians were reported to have heart conditions in 2023, with an above-average death rate of 2,720 per million compared to the world average of 2,350.
The development of lepodisiran represents a targeted approach to a population-specific health challenge, as most Western pharmaceutical companies typically focus their innovative drug development on populations in the US and Europe.
Revolutionary Treatment Approach
Lepodisiran works through RNA interference, a mechanism that silences the production of the LPA protein at a basic level. "This is a pathway where we are silencing an RNA or a protein production at a basic level in a super targeted way and importantly with very long intervals (of dosing)," Ricks said.
One of the most significant advantages of lepodisiran is its dosing regimen—requiring only once-a-year administration to maintain reduced LPA cholesterol levels. Dr. Steven Nissen from the Cleveland Clinic, commenting on the findings presented at the American College of Cardiology meeting, hailed the innovation as an important step forward, noting the absence of serious adverse events in trials conducted so far.
"The drug is very benign, has very few side effects, is easy to administer and suppresses cardiovascular factors for a long period. It is a very important drug for this country," Ricks noted, adding that Indian patients are included in the ongoing global clinical trials.
Current Status and Future Outlook
Lepodisiran is currently in phase 3 clinical trials, with Eli Lilly—now valued at approximately $750 billion—investing significantly in its development as part of its $14 billion annual R&D budget. The company must still demonstrate that the reduction in LPA translates to fewer heart attacks and other cardiovascular events.
The development comes as Eli Lilly recently introduced its weight-loss injectable Mounjaro to the Indian market, signaling the company's growing focus on addressing lifestyle diseases in the region.
Lepodisiran's potential impact extends beyond India to the estimated 1.4 billion individuals globally affected by elevated Lp(a) levels. The treatment represents a significant advancement in cardiovascular medicine, as current cholesterol treatments like statins do not address this specific risk factor.
Competitive Landscape
Eli Lilly is not alone in targeting lipoprotein(a). Other pharmaceutical companies including Silence Therapeutics, Amgen, Novartis, and Merck are also developing treatments for this condition. Last year, Novartis launched Leqvio (inclisiran) in India, a twice-yearly injectable that works on a similar RNA interference mechanism but targets the PCSK9 protein rather than LPA.
The cardiology community is now eagerly awaiting confirmation from the ongoing late-stage clinical trials that reducing Lp(a) directly diminishes cardiovascular risks, which could establish lepodisiran as a breakthrough therapy for a previously unaddressed cardiovascular risk factor that disproportionately affects South Asian populations.
