RX Review: Integrating New Therapies in FCS Treatment Algorithms

With new approvals, the most obvious question for clinicians often becomes: How do I fit this into treatment algorithms?

This same question is being posed by cardiologists across the US as the field welcomed the second approval for familial chylomicronemia syndrome (FCS) with the US Food and Drug Administration approval of plozasiran (Redemplo) in November 2025.
In part 5 of our 7-part video series, host Viet Le, DMSc, PA-C, a preventive cardiology PA at Intermountain Health and the former president of the Academy of Physician Associates in Cardiology, and panelist Christie Ballantyne, MD, chief of cardiovascular research at Baylor College of Medicine and principal investigator of the PALISADE trial, explore how the approvals of olezarsen (Tryngolza) and plozasiran reshape treatment algorithms for FCS.

Ballantyne explains while these agents represent major scientific milestones, they must be incorporated with careful attention to patient needs and existing management principles. Historically, strict dietary restriction has been the cornerstone of therapy, often requiring patients to maintain extremely low-fat intake. Despite the availability of potent medications, Ballantyne reiterates nutritional management remains foundational because it supports medication effectiveness and helps mitigate triggers for pancreatitis.

The segment then focuses on practical integration of therapy. Ballantyne highlights the importance of consistent lipid monitoring and clear communication between lipid specialists, cardiologists, and nutritionists. Medication selection may vary according to patient preference, access considerations, safety profiles, and prior treatment response. The conversation underscores clinicians should provide structured education to ensure patients understand the ongoing role of diet, even when receiving advanced therapies.

Relevant disclosures for Ballantyne include Arrowhead Pharmaceuticals, Inois, Merck, Novartis, Novo Nordisk, New Amsterdam, Esperion, AstraZeneca, Eli Lilly, and others. Relevant disclosures for Le include Amarin, Bayer, Esperion, Idorsia, Janssen, Novo Nordisk, Novartis, Lexicon Pharmaceuticals, and Pfizer.

References:

Arrowhead Pharmaceuticals. Arrowhead Pharmaceuticals Announces FDA Approval of REDEMPLO® (plozasiran) to Reduce Triglycerides in Adults with Familial Chylomicronemia Syndrome (FCS) - Arrowhead Pharmaceuticals, Inc. Arrowhead Pharmaceuticals, Inc. Published November 19, 2025. Accessed November 25, 2025. https://arrowheadpharma.com/news-press/arrowhead-pharmaceuticals-announces-fda-approval-of-redemplo-plozasiran-to-reduce-triglycerides-in-adults-with-familial-chylomicronemia-syndrome-fcs/.

Virani SS, Morris PB, Agarwala A, et al. 2021 ACC Expert Consensus Decision Pathway on the Management of ASCVD Risk Reduction in Patients With Persistent Hypertriglyceridemia: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2021;78(9):960-993. doi:10.1016/j.jacc.2021.06.011

US Food and Drug Administration. FDA approves Tryngolza (olezarsen). U.S. Food and Drug Administration. Published December 19, 2024. Accessed November 25, 2025. https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-drug-reduce-triglycerides-adult-patients-familial-chylomicronemia-syndrome.