Which of the following best describes your level of awareness of the drug bempedoic acid (Nexletol) and the bempedoic acid and ezimibe fixed dose combination (Nexlizet)?

Are you familiar with the clinical data to date for bempedoic acid which has primarily focused on lipid lowering and the ongoing CLEAR-Outcomes study assessing whether bempedoic acid decreases the risk of major cardiovascular events? 

How would you describe your subspecialty? 

How many patients do you see per month, on average?
a. Academic b. Community c. Other, please specify:

How many years in practice do you have?

In patients already on a maximally tolerated statin therapy who have not achieved their LDL goals, what is the next medication you typically prescribe? 
a. Ezetemibeb. Bempedoic Acidc. PCSK9 monoclonal antibody (i.e., evolocumab or alirocumab)d. Inclisirane. Other: Please specify

In patients already on a maximally tolerated statin therapy plus the medication chosen above who have not achieved their LDL goals, what is the next line medication you typically prescribe? 
a. Ezetemibeb. Bempedoic Acidc. PCSK9 monoclonal antibody (i.e., evolocumab or alirocumab)d. Inclisirane. Other: Please specify

What percent of your patients on lipid lowering therapy are at target LDL levels?

What percent of your patients on lipid lowering therapy are on bempedoic acid?
a. 0-5%b. 5-10%c. 10-15%d. 15-20%e. >20%

What is the primary reason you do not prescribe bempedoic acid more frequently?a. Unfamiliarity with the medicationb. Issues with patient tolerabilityc. Magnitude of LDL lowering achieved with the medication is too smalld. Absence of clinical outcomes datae. Absence of sufficient safety dataf. Cost/prior authorization issuesg. Other, please specify:

In patients who you have prescribed bempedoic acid, what line of lipid lowering therapy have you used it? a. Second-line after maximally tolerated statinb. Third-line after maximally tolerated statin + ezetimibec. Third-line after maximally tolerated statin + PCSK9 inhibitord. Fourth-line after maximally tolerated statin + ezetimibe + PCSK9 inhibitor e. I have never prescribed bempedoic acid

In patients who you have opted to prescribe bempedoic acid before starting a PCSK9 inhibitor, what has been your primary reason for doing so? a. I have never prescribed bempedoic acid before trialing a PCSK9 inhibitorb. Patients preferred oral therapy over injectable medicationsc. There were greater cost issues associated with PCSK9 inhibitors compared with bempedoic acidd. Patients preferred the daily dosing of bempedoic acid over the every 2 week dosing of PCSK9 inhibitors e. Other, please specify:

In patients who you have prescribed bempedoic acid, what is their typical LDL level at initiation?a. 55-70 mg/dLb. 70-90 mg/dLc. 90-110 mg/dLd. 110-130 mg/dLe. >130 mg/dLf. I have never prescribed bempedoic acid

What percentage of patients who you have initiated on bempedoic acid remain on it at 1 year?a. 0-25%b. 25-50%c. 50-75%d. 75-100%e. I have never prescribed bempedoic acid

What is your impression on the effectiveness of LDL lowering seen with bempedoic acid alone (Nexletol) in clinical trials or in your clinical practice to date?a. Not effectiveb. Slightly effectivec. Moderately effectived. Highly effective

What is your impression on the effectiveness of LDL lowering seen with bempedoic acid and ezetimibe fixed dose combination (Nexlizet) in clinical trials or in your clinical practice to date?a. Not effective b. Slightly effective c. Moderately effectived. Highly effective

Have you encountered significant access/prior authorization challenges in prescribing bempedoic acid?a. I have not encountered any access challengesb. I have encountered some access challenges that have been easy to navigatec. I have encountered some access challenges that have been difficult to navigate but have mostly been successful in getting patients on drug d. I have encountered significant access challenges that have limited my ability to get patients on drug

Which statement best describes the importance of positive cardiovascular outcomes studies in supporting utilization of an LDL lowering agent?a. Positive outcomes studies are critical to affirming that the LDL reduction achieved with a given therapy class translates to real clinical benefitsb. I am generally comfortable extrapolating the benefit of LDL reduction to outcomes, but payers restrict access in the absence of outcomes data, limiting utilizationc. I am comfortable extrapolating the benefit of LDL reduction, favor drugs that deliver more potent LDL reduction irrespective of outcomes data, and have utilized LDL lowering drugs in the absence of outcomes data. d. Other, please specify: _____

Looking ahead to the upcoming readout of CLEAR-outcomes, how do you expect your prescribing pattern of bempedoic acid to change if the study shows no difference in outcomes with the addition of bempedoic acid?a. I do not expect it to change my prescribing pattern and will continue to initiate patients on it at the same rate b. I will continue bempedoic acid in patients already on it but will not initiate it on new patientsc. I will discontinue bempedoic acid in patients already on it and cease to prescribe it

How do you expect your prescribing pattern of bempedoic acid to change if the study succeeds with a hazard ratio of 0.90-0.92 without significant adverse effects? (for reference PCSK9 trials had a HR of 0.85)a. I will decrease my rate of prescribing bempedoic acidb. I will keep my prescribing rate the samec. I will slightly increase my prescribing rate, adding it on in 0-10% of my patients on lipid lowering therapy d. I will moderately increase my prescribing rate, adding it on in 10-20% of my patients on lipid lowering therapye. I will greatly increase my prescribing rate, adding it on in >20% of my patients on lipid lowering therapy

How do you expect your prescribing pattern of bempedoic acid to change if the study succeeds with a hazard ratio ~ 0.85 without significant adverse effects?a. I will decrease my rate of prescribing bempedoic acidb. I will keep my prescribing rate the same c. I will slightly increase my prescribing rate, adding it on in 0-10% of my patients on lipid lowering therapy d. I will moderately increase my prescribing rate, adding it on in 10-20% of my patients on lipid lowering therapy e. I will greatly increase my prescribing rate, adding it on in >20% of my patients on lipid lowering therapy

How do you expect your prescribing pattern of bempedoic acid to change if the study succeeds with a hazard ratio <=0.80 without significant adverse effects? a. I will decrease my rate of prescribing bempedoic acidb. I will keep my prescribing rate the samec. I will slightly increase my prescribing rate, adding it on in 0-10% of my patients on lipid lowering therapy d. I will moderately increase my prescribing rate, adding it on in 10-20% of my patients on lipid lowering therapye. I will greatly increase my prescribing rate, adding it on in >20% of my patients on lipid lowering therapy

If the CLEAR-outcomes trial succeeds and you opt to add on bempedoic acid, how do you expect to utilize it in patients?a. As second-line medication after maximally tolerated statinb. As third-line medication after maximally tolerated statin + ezetimibec. As fourth-line medication after maximally tolerated statin + ezetimibe + PCSK9 inhibitor

If the CLEAR-outcomes trial succeeds and you opt to add on bempedoic acid to a patient’s regimen, in what percentage of those patients would you use each formulation?  a. Bempedoic acid only (Nexletol – achieves 18-25% LDL-C lowering) b. Bempedoic acid + ezetimibe combination (Nexlizet – achieves 38% LDL-C lowering) 

What result of CLEAR-outcomes would lead you to prescribe bempedoic acid as next line after a maximally tolerated statin?a. There is no result that would lead me to prescribe bempedoic acid as next lineb. Any significant positive result would lead me to prescribe bempedoic acid as next linec. A hazard ratio of 0.80-0.90 would lead me to prescribe bempedoic acid as next lined. A hazard ratio of <0.80 would lead me to prescribe bempedoic acid as next linee. Only a mortality benefit would lead me to prescribe bempedoic acid as next line

In each of the following CLEAR-outcomes study scenarios, in what percentage of your patients on maximally tolerated statin would you add on either nexletol (bempedoic acid) or nexlizet (bempedoic acid + ezetimibe FDC)? a. Study does not reach primary endpoint: b. Study is positive with a marginal HR (0.90-0.92): c. Study is positive with a HR of ~0.85: d. Study is positive with a HR <=0.80: 

Please share additional comments/thoughts on this survey. We value your opinion.