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Lapaquistat acetate (TAK-475) is a small molecule inhibitor of squalene synthase (farnesyl-diphosphate farnesyltransferase), an enzyme that catalyzes the conversion of farnesyl diphosphate to squalene in the cholesterol biosynthesis pathway. This step occurs downstream of the HMG-CoA reductase step targeted by statins. Developed by Takeda, lapaquistat acetate was investigated as a treatment for hypercholesterolemia and dyslipidemia, including a specific Phase 3 study where it was co-administered with existing (current) lipid-lowering therapies—such as statins and ezetimibe—in patients with homozygous familial hypercholesterolemia (HoFH). Although it demonstrated significant LDL cholesterol reduction in clinical trials, Takeda discontinued its development in March 2008 due to hepatic safety concerns, specifically elevations in liver enzymes such as alanine aminotransferase (ALT).
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