The disposition and metabolism of
bempedoic acid, a selective inhibitor of
ATP citrate lyase, were examined in healthy male subjects. After a single administration of [14C]
bempedoic acid (240 mg, 113 μCi) oral
solution, mean concentrations of total radioactivity in plasma as a function of time indicated absorption was rapid with peak concentrations achieved at 1 hour after dose administration. Radioactivity was decreased in a multiexponential fashion with an estimated elimination half-life of 26.0 hours. Radiolabeled dose was predominantly recovered in urine (62.1% of dose) and a smaller amount in feces (25.4% of dose).
Bempedoic acid was extensively metabolized with 1.6%-3.7% of dose excreted unchanged in urine and feces combined. Overall, the major clearance route of
bempedoic acid is metabolism by
uridine 5'-diphosphate glucuronosyltransferases. Metabolism in hepatocyte cultures of human and nonclinical species were generally in agreement with clinical metabolite profiles. Pooled plasma samples were characterized by the presence of
bempedoic acid (ETC-1002), which accounted for 59.3% of total plasma radioactivity, ESP15228 (M7; a reversible keto metabolite of
bempedoic acid), and their respective
glucuronide conjugates. The acyl
glucuronide of
bempedoic acid (M6) represented 23%-36% of radioactivity in plasma and accounted for approximately 37% of dose excreted in urine. In feces, the majority of radioactivity was associated with a co-eluting mixture of a
carboxylic acid metabolite of
bempedoic acid (M2a), a
taurine conjugate of
bempedoic acid (M2c), and hydroxymethyl-ESP15228 (M2b), which collectively accounted for 3.1%-22.9% of
bempedoic acid dose across subjects. SIGNIFICANCE STATEMENT: This study characterizes the disposition and metabolism of
bempedoic acid, an inhibitor of
ATP citrate lyase for
hypercholesterolemia. This work provides further understanding of
bempedoic acid clinical pharmacokinetics and clearance pathways in adult subjects.