Epanova (omega-3-carboxylic acids; AstraZeneca) is a mixture of the free fatty acid forms of EPA (500–600mg/g), DHA (150–250mg/g), and DPA, with higher gastrointestinal absorption of EPA and DHA compared to Lovaza/Omacor. Omega-3 FAs appear to reduce production of triglyceride (TG)-rich very low-density lipoproteins (VLDL) in the liver and increase the removal rate of TG from such lipoproteins. Potential mechanisms include increased mitochondrial and peroxisomal β-oxidation in the liver, inhibition of acyl-CoA:1,2-diacylglycerol acyltransferase, increased lipoprotein lipase activity, and decreased lipogenesis in the liver, possibly through regulation of certain gene transcription factors (peroxisome proliferator-activated receptor, sterol regulatory element-binding protein 1, and carbohydrate-responsive element-binding protein).
For patients with extremely high levels, this lowering of triglyceride may help to prevent pancreatitis. However, while evidence has emerged that EPA may also have a cardiovascular benefit, this is unclear for DHA, given failed CVOTs of EPA/DHA mixtures. The CV benefit may also involve mechanisms other than triglyceride lowering, since the compounds can have differing effects on atherosclerotic plaques and lipid interactions, though some experts feel it is possible that triglyceride lowering could still be the major mechanism. It is not clear whether DPA, a component of Epanova, provides any independent cardiovascular benefit.
LIST OF FIGURES
8 Figure 1: Omega-3 FAs, 4g/day, median reductions in triglycerides
11 Figure 2: Datamonitor Healthcare’s drug assessment summary of Epanova for dyslipidemia
12 Figure 3: Datamonitor Healthcare’s drug assessment summary of Epanova for dyslipidemia
14 Figure 4: Epanova sales for dyslipidemia across the US, Japan, and five major EU markets, by country, 2018–27
LIST OF TABLES
6 Table 1: Epanova drug profile
7 Table 2: Epanova, median changes in triglycerides
9 Table 3: Clinical trials for Epanova in dyslipidemia
10 Table 4: Epanova for dyslipidemia – SWOT analysis
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