Efficacy and safety of Olezarsen in treating hypertriglyceridemia: a systematic review and meta-analysis of randomized controlled trials
Open accessAbstract
Hypertriglyceridemia is a major risk factor for cardiovascular disease and remains poorly managed in high-risk individuals despite existing treatments. Olezarsen, a novel antisense oligonucleotide targeting Apo C-III, has shown reduction in triglyceride levels and potentially reducing cardiovascular risk in hypertriglyceridemia patients. To assess the efficacy and safety of Olezarsen in treating hypertriglyceridemia. A comprehensive search was conducted through PubMed, Cochrane, Embase, Scopus, and ClinicalTrials.gov databases from inception till July 16, 2024. This review included RCTs involving adults (18–65 years) with moderate to severe hypertriglyceridemia (TAG ≥ 200 mg/dL). The dichotomous outcomes were pooled as risk ratio (RR) and continuous outcomes represented as mean % change from baseline with 95% confidence intervals (CI) using the random-effects model. The I 2 and X 2 statistics were employed to evaluate interstudy heterogeneity. All the calculations were performed using RevMan 5.4 and OpenMeta. A p-value of < 0.05 was indicative of statistical significance. This meta-analysis included 4 RCTs with 202 patients. We found a significant mean % change for -65.38% Apo-CIII levels (95% CI − 75.00 to − 55.55, p = 0.000, I 2 = 99.7%), − 44.64% TAGS (95% CI − 55.635 to − 33.649, p = 0.000, I 2 = 99.53%), −14.81% Apo-B (95% CI − 22.05 to − 7.57, p = 0.000, I 2 = 99.39%), 38.85% HDL (95% CI 27.688 to 50.042, p = 0.000, I 2 = 99.55%), and -8.84% total cholesterol (95% CI − 11.483 to − 6.203, p = 0.000, I 2 = 94.92%) from baseline versus placebo. We found reduced risk of any adverse events (RR 0.96, 95% CI 0.87–1.05, p = 0.34 I 2 = 0%), any serious adverse events (RR 0.94, 95% CI 0.44–2.03, p = 0.88, I 2 = 34%) and hypersensitivity reaction (RR 0.65, 95% CI 0.20–2.08, p = 0.47, I 2 = 12%) in Olezarsen group as compared to placebo. Olezarsen is proved to be effective in managing hypertriglyceridemia patients with no significant adverse events. The small sample size and high heterogeneity undermine our findings and more robust studies with larger sample sizes are required to evaluate its full potential.
AI snapshot
Written from the paper’s full text.
TL;DR
This systematic review and meta-analysis of 4 RCTs found Olezarsen significantly reduced Apo-CIII, triglycerides, and other lipid parameters versus placebo, with no significant increase in overall adverse events. However, high heterogeneity and small sample size limit confidence in the findings.
Key findings
- Olezarsen produced significant mean % changes from baseline versus placebo: Apo-CIII −65.38% (95% CI −75.00 to −55.55, p = 0.000, I² = 99.7%), TAG −44.64% (95% CI −55.635 to −33.649, p = 0.000, I² = 99.53%), Apo-B −14.81% (95% CI −22.05 to −7.57, p = 0.000, I² = 99.39%), HDL +38.85% (95% CI 27.688 to 50.042, p = 0.000, I² = 99.55%), and total cholesterol −8.84% (95% CI −11.483 to −6.203, p = 0.000, I² = 94.92%).
- Additional reported efficacy outcomes included VLDL −47.61% (95% CI −50.57 to −44.65, I² = 89.87%), non-HDL −20.74% (95% CI −25.36 to −16.13, I² = 98.78%), and LDL −2.25% (95% CI −12.649 to 8.146, I² = 98.66%).
- Patients achieving normal TAG levels (<200 mg/dL) after 6 months were significantly more frequent with Olezarsen: RR 7.90 (95% CI 4.35–14.35, I² = 0%, p < 0.00001).
- Safety outcomes showed no significant difference for any adverse events (RR 0.96, 95% CI 0.87–1.05, p = 0.34, I² = 0%), any serious adverse events (RR 0.94, 95% CI 0.44–2.03, p = 0.88, I² = 34%), or hypersensitivity reaction (RR 0.65, 95% CI 0.20–2.08, p = 0.47, I² = 12%); renal adverse events were significantly reduced with Olezarsen (RR 0.33, 95% CI 0.12–0.90, p = 0.03, I² = 0%).
Methods
- Systematic review and meta-analysis of randomized controlled trials, reported per PRISMA and conducted according to the Cochrane Handbook.
- Searched PubMed, Embase, Scopus, Cochrane, and ClinicalTrials.gov from inception to July 16, 2024; included adults 18–65 years with moderate to severe hypertriglyceridemia (fasting TAG ≥ 200 mg/dL). Four RCTs were included, with 202 vs 172 patients in Olezarsen and placebo groups respectively (the discussion reports 298 total participants).
- Dichotomous outcomes pooled as risk ratios (RR) and continuous outcomes as mean % change from baseline with 95% CIs using random-effects models; heterogeneity assessed with I² and χ²; analyses performed in RevMan 5.4 and OpenMeta; risk of bias assessed with RoB 2.0.
Limitations
- Stated by the paper: small sample size of included studies limits reliability and generalizability; high heterogeneity undermines findings; treatment adherence, patient compliance, and cost-effectiveness were not addressed; cardiovascular outcomes, FCS/pancreatitis risk, and long-term side effects of prolonged use were not assessed.
- Evident from the text: the abstract states “4 RCTs with 202 patients,” while the results and discussion describe 202 vs 172 patients and 298 total participants, indicating inconsistent reporting of the analyzed population.
- Evident from the text: funnel plots were not used for publication bias because the recommended minimum of 10 studies per outcome was not reached.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
8 of 16 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured
- Premisecitation
The targeted delivery of Olezarsen to hepatocytes reduces hypertriglyceridemia more effectively than current medications.
“The targeted delivery of the olezarsen to the hepatocyte reduces hypertriglyceridemia more effectively than current medications [8,9].”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [8] Gaudet D, Clifton P, Sullivan D, Baker J, Schwabe C, Thackwray S, et al. RNA interference therapy targeting apolipoprotein C-III in hypertriglyceridemia. NEJM Evid. 2023. https://doi.org/10.1056/EVIDoa2200325. source
- cites [9] Kolovou G, Kolovou V, Katsiki N. Volanesorsen: a new era in the treatment of severe hypertriglyceridemia. J Clin Med. 2022;11:982. https://doi.org/10.3390/jcm11040982. source
The Case Presentation and Expert Opinion discuss triglyceride reductions with volanesorsen, not olezarsen. Searches for olezarsen and hepatocyte-targeted delivery found no passage addressing olezarsen’s delivery or comparing its effectiveness with current medications. (LLM, conf=0.76)
Experimental — accuracy not yet measured
- Interpretationcitation
Olezarsen has a more favorable side effect profile compared to Volanesorsen.
“Olezarsen also shows a more favorable side effect profile compared to its predecessor, Volanesorsen.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [9] Kolovou G, Kolovou V, Katsiki N. Volanesorsen: a new era in the treatment of severe hypertriglyceridemia. J Clin Med. 2022;11:982. https://doi.org/10.3390/jcm11040982. source
Section 2.2 (page not provided) reports injection-site reactions and thrombocytopenia among volanesorsen-treated patients, supporting the side-effect concern about that drug. The copy does not report olezarsen safety or compare the two drugs, so it does not establish that olezarsen has a more favorable side-effect profile. (LLM, conf=0.82)
Experimental — accuracy not yet measured
- Rests on an assumption: Olezarsen has a relatively better safety profile with no major adverse events compared to Volanesorsen.
- Findingown data
Olezarsen reduced Apo-CIII levels by a mean of -65.38% from baseline versus placebo (95% CI -75.00 to -55.55/55.77, p=0.000, I2=99.7%).
“We found a significant mean % change for -65.38%Apo-CIII levels (95% CI -75.00 to -55.55, p = 0.000, I 2 = 99.7%)”
- Also stated in: § 3.16 Change in mean % apolipoprotein C-III (Apo-C III) · plain
“We found a significant mean % change of -65.38%APO C-III (95% CI -75.00 to -55.77%,I 2 = 99.7%,P = 0.000)”
Quote in the paperSubstantial claim - Also stated in: § 3.16 Change in mean % apolipoprotein C-III (Apo-C III) · plain
- Findingown data
There is no difference in risk of GFR reduction >25% between Olezarsen and placebo (RR 0.69, 95% CI 0.44-1.10, I2=0%, P=0.12).
“we found that there is no difference of risk of GFR reduction in the Olezarsen group (RR 0.69, 95% CI 0.44-1.10,I 2 = 0%, P = 0.12) between two groups”
Quote in the paperSubstantial claim - Findingown data
Olezarsen reduced total cholesterol by a mean of -8.84% from baseline versus placebo (95% CI -11.483 to -6.203, p=0.000, I2=94.92%).
“We found a significant mean % change of -8.84%Total Cholesterol (95% CI -11.483 to -6.203%,I 2 = 94.92%,P = 0.000)”
Quote in the paperSubstantial claim
- Findingown data
Olezarsen reduced LDL cholesterol by a mean of -2.25% from baseline versus placebo (95% CI -12.649 to 8.146, p=0.000, I2=98.66%).
“We found a significant mean % change of -2.25% LDL Cholesterol (95% CI -12.649 to 8.146%, I 2 = 98.66%,P = 0.000)”
Quote in the paperNot a substantial claim - Findingown data
Olezarsen reduced TAG levels by a mean of -44.64% from baseline versus placebo (95% CI -55.63 to -33.64, p=0.000, I2=99.53%).
“We found a significant mean % change of -44.64%TAG (95% CI -55.63 to -33.64%,I 2 = 99.53%,P = 0.000).”
Quote in the paperSubstantial claim - Findingown data
There is no difference in risk of any serious adverse events between Olezarsen and placebo (RR 0.94, 95% CI 0.44-2.03, I2=34%, P=0.88).
“we found that there is no difference of risk of any serious adverse events between the two groups (RR 0.94, 95% CI 0.44-2.03,I 2 = 34%, P = 0.88)”
Quote in the paperSubstantial claim - Findingown data
Olezarsen increased the number of patients achieving normal TAG levels (<200 mg/dL) after 6 months compared with placebo (RR 7.90, 95% CI 4.35-14.35, I2=0%, P<0.00001).
“we found a statistically significant number of patients with normal TAG levels after 6 months in the Olezarsen group (RR 7.90, 95% CI 4.35-14.35,I 2 = 0%, P < 0.00001)”
Quote in the paperSubstantial claim - Findingown data
This meta-analysis included 4 randomized controlled trials.
“This meta-analysis included 4 RCTs with 202 patients.”
- Also stated in: § 3.1 Study selection process · plain
“A total of 4 studies [15][16][17][18] fulfilling the predefined inclusion and exclusion criteria were included in this systematic review and meta-analysis.”
Quote in the paperSubstantial claim - Also stated in: § 3.1 Study selection process · plain
- Findingown data
Olezarsen reduced Apo-B levels by a mean of -14.815% from baseline versus placebo (95% CI -22.057 to -7.573, p=0.000, I2=99.39%).
“We found a significant mean % change of -14.815%Apolipoprotein B (95% CI -22.057 to -7.573%,I 2 = 99.39%,P = 0.000)”
Quote in the paperSubstantial claim - Findingown data
There is no difference in risk of AST elevation ≥3xULN between Olezarsen and placebo (RR 1.27, 95% CI 0.24-6.84, I2=0%, P=0.78).
“we found that there is no difference of risk of AST elevation in Olezarsen (RR 1.27, 95% CI 0.24-6.84,I 2 = 0%, P = 0.78) between two groups”
Quote in the paperSubstantial claim - Findingown data
Olezarsen reduced VLDL cholesterol by a mean of -47.61% from baseline versus placebo (95% CI -50.57 to -44.65, p=0.000, I2=89.87%).
“We found a significant mean % change of -47.61% VLDL Cholesterol (95% CI -50.57 to -44.65%,I 2 = 89.87%,P = 0.000)”
Quote in the paperSubstantial claim - Findingown data
There is no difference in risk of any adverse events between Olezarsen and placebo (RR 0.96, 95% CI 0.87-1.05, I2=0%, P=0.34).
“We found that there is no difference of risk of adverse events between the two groups (RR 0.96, 95% CI 0.87-1.05,I 2 = 0%, P = 0.34)”
Quote in the paperSubstantial claim - Findingown data
There is no difference in risk of hypersensitivity reaction between Olezarsen and placebo (RR 0.65, 95% CI 0.20-2.08, I2=12%, P=0.47).
“we found that there is no difference of risk of developing hypersensitivity reaction in the Olezarsen group (RR 0.65, 95% CI 0.20-2.08,I 2 = 12%, P = 0.47) between two groups”
Quote in the paperSubstantial claim - Findingown data
Olezarsen increased HDL cholesterol by a mean of 38.865% from baseline versus placebo (95% CI 27.688 to 50.042, p=0.000, I2=99.55%).
“We found a significant mean % change in 38.865% HDL Cholesterol (95% CI 27.688 to 50.042%,I 2 = 99.55%,P = 0.000)”
Quote in the paperSubstantial claim - Findingown data
There is no difference in risk of ALT elevation ≥3xULN between Olezarsen and placebo (RR 0.87, 95% CI 0.16-4.69, I2=20%, P=0.87).
“we found that there is no difference of risk of ALT elevation between the two groups (RR 0.87, 95% CI 0.16-4.69,I 2 = 20%, P = 0.87)”
Quote in the paperSubstantial claim - Findingown data
Olezarsen reduced non-HDL cholesterol by a mean of -20.74% from baseline versus placebo (95% CI -25.36 to -16.13, p=0.000, I2=98.78%).
“We found a significant mean % change of -20.74% non-HDL Cholesterol (95% CI -25.36 to -16.13%,I 2 = 98.78%,P = 0.000)”
Quote in the paperSubstantial claim - Findingown data
Olezarsen reduced risk of any renal adverse events compared with placebo (RR 0.33, 95% CI 0.12-0.90, I2=0%, P=0.03).
“we found that there is statistically significant reduced risk of renal adverse events between the two groups (RR 0.33, 95% CI 0.12-0.90,I 2 = 0%, P = 0.03), with overall results favoring Olezarsen”
Quote in the paperSubstantial claim - Findingown data
This study integrates data from four RCTs with a total of 298 participants.
“This study integrates data from four RCTs with a total of 298 participants.”
Quote in the paperSubstantial claim - Findingown data
The safety analysis showed no statistically significant difference in the occurrence of adverse events between the Olezarsen and control groups.
“The safety analysis showed no statistically significant difference in the occurrence of adverse events between the Olezarsen and control groups.”
Quote in the paperSubstantial claim - Interpretationown data
The small sample size and high heterogeneity undermine the findings of this meta-analysis.
“The small sample size and high heterogeneity undermine our findings”
Quote in the paperSubstantial claim - Interpretationreasoning
The low risk of bias enhances the reliability of the findings for clinical practice.
“This enhances the reliability of our findings for clinical practice.”
Quote in the paperSubstantial claim - Study design and conductnone given
The reliability and generalizability of the findings may be limited by the small sample size of included studies.
“Firstly, the reliability and generalizability of our findings may be limited by the small sample size of included studies.”
Quote in the paperSubstantial claim - Study design and conductown data
The overall risk of bias in the included studies was low in all five domains.
“We found an overall 'low' risk of bias in all five domains which indicates consistency and high quality among the included studies.”
Quote in the paperNot a substantial claim
- May combine two claims. 16
- Classified as probably not a substantial claim. 5
May combine two claims.
PremisecitationDespite advancements in dyslipidemia management, many individuals with hypertriglyceridemia remain inadequately managed, particularly those at high cardiovascular risk.
“Despite advancements in dyslipidemia management, many individuals with hypertriglyceridemia remain inadequately managed, particularly those at high cardiovascular risk who demand more aggressive therapeutic strategies [3].”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [3] Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, et al. 2016 ESC/EAS guidelines for the management of dyslipidaemias. Eur Heart J. 2016;37:2999–3058. https://doi.org/10.1093/eurheartj/ehw272. source
Section 7.3 (p. 33) recommends considering drug treatment for high-risk patients with elevated triglycerides, supporting the need for additional treatment in some cases. It does not establish that many people with hypertriglyceridaemia are inadequately managed, and its recommendations are conditional rather than a general call for more aggressive treatment. (LLM, conf=0.84)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationPharmacological therapies such as fibrates, statins, niacin, and omega-3 fatty acids, as well as lifestyle adjustments, are currently available therapeutic options for controlling hypertriglyceridemia, but often have drawbacks regarding effectiveness, tolerability, and ability to significantly reduce triglyceride levels necessary to lower cardiovascular risk.
“Pharmacological therapies such as fibrates, statins, niacin, and omega-3 fatty acids, as well as lifestyle adjustments, are currently available therapeutic options for controlling hypertriglyceridemia. Nevertheless, these therapies often have drawbacks regarding their effectiveness, tolerability, and ability to significantly reduce triglyceride levels necessary to lower cardiovascular risk [4,5].”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [4] Berglund L, Brunzell JD, Goldberg AC, Goldberg IJ, Stalenhoef A. Treatment options for hypertriglyceridemia: From risk reduction to pancreatitis. Best Pract Res Clin Endocrinol Metab. 2014;28:423–37. https://doi.org/10.1016/j.beem.2013.10.002. source
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured - cites [5] Gouni-Berthold I, Schwarz J, Berthold HK. Updates in drug treatment of severe hypertriglyceridemia. Curr Atheroscler Rep. 2023;25:701–9. https://doi.org/10.1007/s11883-023-01140-z. source
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationOlezarsen binds to the mRNA of ApoC-III, resulting in increased destruction and decreased expression of mRNA, leading to reduction of ApoC-III level and ultimately decreases triglycerides levels.
“It binds to the mRNA of ApoC-III resulting in the increased destruction and decreased expression of mRNA.This leads to reduction of ApoC-III level and ultimately decreases the triglycerides levels [1,7].”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [1] Mikhail N. Appraisal of olezarsen for treatment of hypertriglyceridemia. Int J Endovasc Treat Innov Tech. 2024;5:41–8. source
The Introduction identifies olezarsen as an antisense oligonucleotide targeting APOC3 mRNA, and the Effects section says it inhibits APOC3 mRNA expression and lowers ApoC3 levels. The Abstract links reduced ApoC3 synthesis to lower triglycerides. Our copy does not state that olezarsen increases destruction of the mRNA; page numbers are unavailable. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites [7] Mikhail N. Appraisal of olezarsen for treatment of hypertriglyceridemia. Int J Endovasc Treat Innov Tech. 2024;5:41–8. https://doi.org/10.6179/ijetit.v5i1.334. source
Not checked in the free run.
May combine two claims.
PremisecitationApoC-III is a key regulator of triglyceride metabolism, and its inhibition has been proven effective in lowering triglyceride levels in preclinical studies and early clinical trials.
“ApoC-III is a key regulator of triglyceride metabolism, and its inhibition has been proven effective in lowering triglyceride levels in preclinical studies and early clinical trials.”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [1] Mikhail N. Appraisal of olezarsen for treatment of hypertriglyceridemia. Int J Endovasc Treat Innov Tech. 2024;5:41–8. source
The Introduction describes ApoC-III’s role in raising triglycerides, and the section on olezarsen in patients at high cardiovascular risk reports substantial triglyceride reductions in phase 2 trials (page numbers unavailable). The passages do not report triglyceride-lowering efficacy in preclinical studies, so that part of the claim is unsupported by our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measured - cites [6] Valdivielso P, Coca PI. Apolipoprotein C-III, familial chylomicronemia syndrome, and olezarsen. Med. 2024;5:493–4. https://doi.org/10.1016/j.medj.2024.05.004. source
May combine two claims.
PremisecitationVolanesorsen is effective in treating hypertriglyceridemia but is often associated with injection site reactions and a risk of thrombocytopenia, requiring regular platelet monitoring.
“While Volanesorsen is effective in treating hypertriglyceridemia, it is often associated with injection site reactions and a risk of thrombocytopenia, requiring regular platelet monitoring [9].”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [9] Kolovou G, Kolovou V, Katsiki N. Volanesorsen: a new era in the treatment of severe hypertriglyceridemia. J Clin Med. 2022;11:982. https://doi.org/10.3390/jcm11040982. source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataAmong the participants, 101 received 50 mg, 79 received 80 mg, 22 received 10 mg, and 6 received 60 mg of Olezarsen every 4 weeks, while 90 were in the placebo group.
“Among these, 101 received 50 mg, 79 were given 80 mg, 22 took 10 mg, and 6 were administered 60 mg of Olezarsen every 4 weeks, while 90 participants were in the placebo group.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe risk ratios for any adverse events and serious adverse events were comparable between Olezarsen and control groups.
“Specifically, the risk ratios (RR) for any adverse events (RR 0.96, 95% CI 0.87-1.05)and serious adverse events (RR 0.94, 95% CI 0.44-2.03)were comparable.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductown dataTwo independent authors screened the retrieved references based on title, abstracts and relevant outcomes and assessed eligibility, with a third independent reviewer resolving discrepancies.
“The retrieved references were screened based on title, abstracts and relevant outcomes and assessed for eligibility on predefined inclusion and exclusion criteria by two independent authors (R.D. and R.T.).A third independent reviewer (M.N.S.) was employed to resolve any discrepancy.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationRisk of bias of included studies was assessed using RoB 2.0 software by the Cochrane Collaboration.
“The risk of bias of the included studies in five domains i.e. selection bias, performance bias, detection bias, attrition bias and reporting bias was assessed using RoB 2.0 software by the Cochrane Collaboration [14].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [14] Chandler J, McKenzie J, Boutron I, Welch V. Cochrane methods 2016. Wiley. 2016. https://doi.org/10.1002/14651858.CD201601. source
May combine two claims.
Interpretationown dataOlezarsen is effective in managing hypertriglyceridemia patients with no significant adverse events.
“Olezarsen is proved to be effective in managing hypertriglyceridemia patients with no significant adverse events.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataData were extracted by two independent reviewers, with a third independent reviewer resolving discrepancies.
“The data of the included studies was extracted by two independent reviewers (S.H. and P.S.) regarding study characteristics, intervention, comparison, and study outcomes.”
- Also stated in: § 2.4 Data extraction and quality assessment · plain
“A third independent reviewer (A.R.) was employed to resolve any discrepancy.”
Quote in the paperNot a substantial claim- Also stated in: § 2.4 Data extraction and quality assessment · plain
May combine two claims.
PremisecitationBoth Olezarsen and Plozasiran have demonstrated efficacy in reducing plasma apoC-III and triglyceride levels.
“Both have demonstrated efficacy in reducing plasma apoC-III and triglyceride levels [22].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [22] Chebli J, Larouche M, Gaudet D. APOC3 siRNA and ASO therapy for dyslipidemia. Curr Opin Endocrinol Diabetes Obes. 2024;31:70–7. https://doi.org/10.1097/MED.0000000000000857. source
May combine two claims.
Interpretationown dataOlezarsen significantly reduces triacylglycerol, total cholesterol, and VLDL levels in hypertriglyceridemia patients.
“Our systematic review and meta-analysis highlight the efficacy of Olezarsen to significantly reduce triacylglycerol, total cholesterol, and VLDL levels in hypertriglyceridemia patients”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductown dataThis meta-analysis incorporates high-quality RCTs with minimal risk of bias and low heterogeneity across studies.
“Our meta-analysis incorporates high-quality RCTs with minimal risk of bias and low heterogeneity across studies.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationThe favorable safety profile of Olezarsen can be attributed to its ASO-GalNAC3 conjugate design, which ensures targeted delivery to hepatocytes and reduced systemic exposure, resulting in low immunogenicity and reduced hypersensitivity and thrombocytopenia.
“This favorable safety profile can be attributed to ASO-GalNAC3 conjugate design of Olezarsen which ensures targeted delivery of the drug to the hepatocytes and reduced systematic exposure resulting in low immunogenicity and reduced hypersensitivity and thrombocytopenia [8].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [8] Gaudet D, Clifton P, Sullivan D, Baker J, Schwabe C, Thackwray S, et al. RNA interference therapy targeting apolipoprotein C-III in hypertriglyceridemia. NEJM Evid. 2023. https://doi.org/10.1056/EVIDoa2200325. source
May combine two claims.
Interpretationown dataOlezarsen has an improved safety profile and no notable liver-related adverse effects in comparison to other apoC-III inhibitors, such as Plozasiran and Volanesorsen.
“with improved safety profile and no notable liver-related adverse effects in comparison to other apoC-III inhibitors, such as Plozasiran and Volanesorsen.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe primary apo C-III inhibitors in advanced clinical development are GalNAc-ASO Olezarsen and ARO-APOC3 Plozasiran.
“The primary apo C-III inhibitors in advanced clinical development are GalNAc-ASO Olezarsen and ARO-APOC3 Plozasiran.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [22] Chebli J, Larouche M, Gaudet D. APOC3 siRNA and ASO therapy for dyslipidemia. Curr Opin Endocrinol Diabetes Obes. 2024;31:70–7. https://doi.org/10.1097/MED.0000000000000857. source
May combine two claims.
Interpretationown dataUnlike Plozasiran, which is associated with mild to moderate elevations in liver transaminases, this study found no such liver-related adverse effects with Olezarsen, indicating a superior safety and tolerability profile.
“However, unlike Plozasiran, which is associated with mild to moderate elevations in liver transaminases [8], our study found no such liver-related adverse effects with Olezarsen, indicating a superior safety and tolerability profile.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [8] Gaudet D, Clifton P, Sullivan D, Baker J, Schwabe C, Thackwray S, et al. RNA interference therapy targeting apolipoprotein C-III in hypertriglyceridemia. NEJM Evid. 2023. https://doi.org/10.1056/EVIDoa2200325. source
The paper relies on this without support.
The safety and efficacy of Olezarsen in hypertriglyceridemia remain unexplored.
“Previous studies highlight the triglyceride-lowering potential of Olezarsen, yet its safety and efficacy in hypertriglyceridemia remain unexplored.”
The paper relies on this without support.
Olezarsen has a relatively better safety profile with no major adverse events compared to Volanesorsen.
“Compared to its predecessor, Volanesorsen, which cause thrombocytopenia and injection site reactions, Olezarsen has a relatively better safety profile with no major adverse events.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
LDL result is called significant despite a confidence interval crossing zero
MajorThe reported LDL mean-change confidence interval runs from −12.649% to 8.146%, including zero, yet the result is called significant and assigned P = 0.000. This also conflicts with the claim that all efficacy outcomes were significant.
“We found a significant mean % change of -2.25% LDL Cholesterol (95% CI -12.649 to 8.146%, I 2 = 98.66%,P = 0.000) from baselines versus placebo at various doses.”
“The overall effect of Olezarsen was statistically significant in all the outcomes with a p-value < 0.001”
Inconsistent participant totals for the four trials
MajorThe results describe 202 olezarsen and 172 placebo patients (374 total), whereas the discussion describes 298 participants, including 208 assigned to olezarsen doses and 90 to placebo.
“This meta-analysis included 202 vs 172 patients in Olezarsen and placebo groups respectively, of which 60% were males.”
“This study integrates data from four RCTs with a total of 298 participants.Among these, 101 received 50 mg, 79 were given 80 mg, 22 took 10 mg, and 6 were administered 60 mg of Olezarsen every 4 weeks, while 90 participants were in the placebo group.”
Discussion claims low heterogeneity despite high reported I2 values
MajorThe discussion calls heterogeneity low, whereas the results explicitly call it very high and report efficacy-outcome I2 values ranging from 89.87% to 99.7%.
“Our meta-analysis incorporates high-quality RCTs with minimal risk of bias and low heterogeneity across studies.”
“For all the outcomes, the I 2 statistic indicated a very high level of heterogeneity across studies, meaning that there's substantial variability in the study results that cannot be explained by random sampling error alone.”
Alexander study year differs across tables
MinorTable 3 dates the included Alexander study to 2019, while Table 2 dates the study with the same citation number to 2024.
“| Alexander et al., 2019 [17] | 6 | 4 | 60 mg/4 week | | -64.6 ± 16.2 | |”
“| Alexander et al., 2024 [17] | 6 | 4 | 60 mg / 4 week | | |”
Apo C-III confidence-interval endpoint differs between abstract and results
MinorFor the same −65.38% Apo C-III estimate, the abstract gives an upper confidence limit of −55.55%, while the results give −55.77%.
“-65.38%Apo-CIII levels (95% CI -75.00 to -55.55, p = 0.000, I 2 = 99.7%)”
“-65.38%APO C-III (95% CI -75.00 to -55.77%,I 2 = 99.7%,P = 0.000)”
Control-group count differs between tables
MinorTable 1 lists 39 control patients for Bergmark et al., while Table 2 lists 78 for the same study. The tables do not explain why the study's control group doubles.
“| Control (n) 23 39 24 4 |”
“| Bergmark et al., 2024 [15] | 115 | 78 | 50 mg / 4 week | 80 mg / 4 week | 42/58; 38/57 |”
Cites
2016 ESC/EAS Guidelines for the Management of Dyslipidaemias
Catapano, A. L., Graham, I., De Backer, G., Wiklund, O., Chapman, M. J., Drexel, H., Hoes, A. W., Jennings, C. S., Landmesser, U., Pedersen, T. R., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw272 · Cited by 3,162 · see citing works
(2016) · doi:10.1002/14651858.cd201601 · Cited by 278 · see citing works
Olezarsen, Acute Pancreatitis, and Familial Chylomicronemia Syndrome
Stroes, E. S. G., Alexander, V. J., Karwatowska-Prokopczuk, E., Hegele, R. A., Arca, M., Ballantyne, C. M., Soran, H., Prohaska, T. A., Xia, S., Ginsberg, H. N., et al. (2024) · New England Journal of Medicine · doi:10.1056/nejmoa2400201 · Cited by 271 · cited 1× · see citing works
“Conventional therapies such as fibrates and omega-3 fatty acids have been ineffective in lowering TG levels in FCS patients, Olezarsen has shown promising results [16, 19].”
Alexander, V. J., Xia, S., Hurh, E., Hughes, S. G., O’Dea, L., Geary, R. S., Witztum, J. L., & Tsimikas, S. (2019) · European Heart Journal · doi:10.1093/eurheartj/ehz209 · Cited by 231 · cited 1× · see citing works
“A l e x a n d e r e t a l ., 2019 [ 17 ] N o . o f p a t i e n t s”
Tardif, J.-C., Karwatowska-Prokopczuk, E., Amour, E. S., Ballantyne, C. M., Shapiro, M. D., Moriarty, P. M., Baum, S. J., Hurh, E., Bartlett, V. J., Kingsbury, J., et al. (2022) · European Heart Journal · doi:10.1093/eurheartj/ehab820 · Cited by 210 · cited 1× · see citing works
“A total of 4 studies [15–18] fulfilling the predefined inclusion and exclusion criteria were included in this systematic review and meta-analysis.”
Lipid and Lipoprotein Metabolism
Feingold, K. R. (2022) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2022.02.008 · Cited by 198 · see citing works
Olezarsen for Hypertriglyceridemia in Patients at High Cardiovascular Risk
Bergmark, B. A., Marston, N. A., Prohaska, T. A., Alexander, V. J., Zimerman, A., Moura, F. A., Murphy, S. A., Goodrich, E. L., Zhang, S., Gaudet, D., et al. (2024) · New England Journal of Medicine · doi:10.1056/nejmoa2402309 · Cited by 198 · cited 1× · see citing works
“A total of 4 studies [15–18] fulfilling the predefined inclusion and exclusion criteria were included in this systematic review and meta-analysis.”
RNA Interference Therapy Targeting Apolipoprotein C-III in Hypertriglyceridemia
Gaudet, D., Clifton, P., Sullivan, D., Baker, J., Schwabe, C., Thackwray, S., Scott, R., Hamilton, J., Given, B., Melquist, S., et al. (2023) · NEJM Evidence · doi:10.1056/evidoa2200325 · Cited by 71 · cited 3× · see citing works
“The targeted delivery of the olezarsen to the hepatocyte reduces hypertriglyceridemia more effectively than current medications [8, 9].”
Updates in Drug Treatment of Severe Hypertriglyceridemia
Gouni-Berthold, I., Schwarz, J., & Berthold, H. K. (2023) · Current Atherosclerosis Reports · doi:10.1007/s11883-023-01140-z · Cited by 59 · cited 1× · see citing works
“Nevertheless, these therapies often have drawbacks regarding their effectiveness, tolerability, and ability to significantly reduce triglyceride levels necessary to lower cardiovascular risk [4, 5].”
Rocha, N. A., East, C., Zhang, J., & McCullough, P. A. (2017) · Current Atherosclerosis Reports · doi:10.1007/s11883-017-0697-3 · Cited by 54 · cited 1× · see citing works
“Apo CIII inhibits lipoprotein lipase(LPL) and promotes the development of atherosclerosis, attachment of monocytes to endothelial cells, smooth muscle cell proliferation, and increasing oxidative stress, thereby posing cardiovascular risk [20, 21].”
Treatment options for hypertriglyceridemia: From risk reduction to pancreatitis
Berglund, L., Brunzell, J. D., Goldberg, A. C., Goldberg, I. J., & Stalenhoef, A. (2014) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2013.10.002 · Cited by 50 · cited 1× · see citing works
“Nevertheless, these therapies often have drawbacks regarding their effectiveness, tolerability, and ability to significantly reduce triglyceride levels necessary to lower cardiovascular risk [4, 5].”
APOC3 siRNA and ASO therapy for dyslipidemia
Chebli, J., Larouche, M., & Gaudet, D. (2024) · Current Opinion in Endocrinology, Diabetes & Obesity · doi:10.1097/med.0000000000000857 · Cited by 35 · cited 1× · see citing works
“Both have demonstrated efficacy in reducing plasma apoC-III and triglyceride levels [22].”
Volanesorsen: A New Era in the Treatment of Severe Hypertriglyceridemia
Kolovou, G., Kolovou, V., & Katsiki, N. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11040982 · Cited by 33 · cited 2× · see citing works
“The targeted delivery of the olezarsen to the hepatocyte reduces hypertriglyceridemia more effectively than current medications [8, 9].”
Apolipoprotein C-III, familial chylomicronemia syndrome, and olezarsen
Valdivielso, P., & Coca Prieto, I. (2024) · Med · doi:10.1016/j.medj.2024.05.004 · Cited by 5 · see citing works
Lipoprotein apheresis: a Hellenic consensus on its clinical use
Kolovou, G. D., Kolovou, V., Bilianou, H. I., Goumas, G. S., Foussas, S. G., Grapsa, E., Garoufi, A., Karavolias, G., Mavrogieni, S., Melidonis, A. J., et al. (2020) · Hellenic Journal of Cardiology · doi:10.1016/j.hjc.2020.12.010 · Cited by 4 · cited 1× · see citing works
“Conventional therapies such as fibrates and omega-3 fatty acids have been ineffective in lowering TG levels in FCS patients, Olezarsen has shown promising results [16, 19].”
The year in cardiovascular medicine 2022: the top 10 papers in dyslipidaemias
Tokgözoğlu, L. S., Orringer, C. E., & Catapano, A. L. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehac750 · Cited by 2 · cited 1× · see citing works
“This risk is pronounced particularly in individuals with other metabolic syndrome components or pre-existing cardiovascular disease [1, 2].”
Appraisal of Olezarsen for Treatment of Hypertriglyceridemia
Mikhail, N. (2024) · International Journal of Endovascular Treatment and Innovative Techniques · doi:10.61797/ijetit.v5i1.334 · Cited by 2 · cited 1× · see citing works
“This leads to reduction of ApoC-III level and ultimately decreases the triglycerides levels [1, 7].”
Flagged first, then by citations
Research works printed but not linked: 1
- Mikhail N. Appraisal of olezarsen for treatment of hypertriglyceridemia. Int J Endovasc Treat Innov Tech. 2024;5:41–8. https://doi.org/10.6179/ijetit.v5i1.334. · DOI
Cited by
Sorted by citations
Genetic Assessment and Clinical Correlates in Severe Hypertriglyceridemia: A Systematic Review
Luca, C. D., Ciciola, P., D’Errico, G., Taranto, M. D. D., Fortunato, G., Gross, C., Garn, J., Iannuzzo, G., Minno, M. N. D. D., & Calcaterra, I. L. (2025) · Genes · doi:10.3390/genes16111377 · Cited by 7 · see citing works
“Ultimately, 10 studies met the inclusion criteria and were incorporated into the qualitative and quantitative synthesis, encompassing 2521 patients with severe or refractory hypertriglyceridemia (SHTG) [15,32,37–44].”
Rehman, A., Rajdeep, D., Mohnkern, J. D., & Lin, J. (2026) · Digestive Diseases and Sciences · doi:10.1007/s10620-026-09846-1 · Cited by 2 · see citing works
“In patients with SHTG, particularly those with FCS, the primary therapeutic goal is to reduce TG levels to prevent recurrent episodes of acute pancreatitis [23].”
Self-citationJoshy, J., Javed, A., Singh, M. K., Singh, B., Kumar, R., & Hussain, S. (2025) · Cureus · doi:10.7759/cureus.96715 · Cited by 1 · see citing works
“As a GalNAc-conjugated antisense oligonucleotide, olezarsen also demonstrates how targeted delivery improves both efficacy and safety compared with earlier agents such as volanesorsen [43].”
Ahmad, C. M., Kastle, R.-A., Patel, H., Haberman, S. R., & Youkhana, M. (2026) · Cureus · doi:10.7759/cureus.105594
“In parallel, the patient continued olezarsen under a triglyceride clinic, reflecting the incorporation of an emerging RNA-based approach to the management of severe hypertriglyceridemia [11,12].”
Burhan, M., Ibrahim, T., Naveed, M. A., Ansari, Z., Ansab, M., Fatima, K., Ashraf, S., Shahid, Z. U. A., Raza, A., & Raza, S. H. A. (2026) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2026.03.052
Soran, H., Kessler, A. S., Vera-Llonch, M., Alexander, V. J., Serafini, P., Pushkarna, D., Rodrigues, E., Stroes, E. S. G., Schatz, U., Kassner, U., et al. (2026) · Journal of Comparative Effectiveness Research · doi:10.57264/cer-2026-0069
- Authors
- Saddique, M. N., Thapa, R., Khan, Y., Javaid, H., Khawar, M. M., Rehman, A., Dave, R., Raval, R., Hejmadi, S., Singh, P., Rodriguez, P. R. T., Hussain, M., Raza, H., Ahmed, S., Shamoon, S., & Iqbal, J.
- Affiliations
- King Edward Medical University (PK)
- Crozer-Keystone Health System (US)
- Khyber Medical University (PK)
- Ayub Medical College (PK)
- B.J. Medical College (IN)
- Nepalese Army Institute of Health Services (NP)
- Universidad Privada del Valle (BO)
- Services Institute of Medical Sciences (PK)
- International University of Kyrgyzstan (KG)
- Rawalpindi Medical University (PK)
- Hamad Medical Corporation (QA)
- Corresponding author
- Iqbal, Javed
- ORCID
- Venue
- Discover Medicine
- Published
- 2025-05-06
- Volume
- 2
- Issue
- 1
- ISSN
- 3004-8885 (ISSN-L)
- OpenAlex
- W4410122404
- Semantic Scholar
- c1b08ae44915802b64053a2a783533133745e1ef
- Cited by
- 6
- References
- 17
- Citations by year
- 2026: 4 · 2025: 2
- FWCI
- 1.94
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Discover Medicine (publishedVersion, cc-by-nc-nd)
- Funders
- Qatar National Library
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- olezarsen, hypertriglyceridemia, antisense oligonucleotides, apolipoprotein C-III, triglycerides, apolipoprotein B, HDL cholesterol, total cholesterol, cardiovascular risk, drug safety, adverse events, drug efficacy, severe hypertriglyceridemia, dyslipidemia management, lipoprotein metabolism, triglyceride-rich lipoproteins
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-19.
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