Should Patients Continue Taking Sezome (Hibemib) Long-Term After Achieving Normal Cholesterol Levels?

For patients prescribed bempedoic acid tablets (brand name: Seleme), a key question often arises: Is long-term therapy required, and can treatment be discontinued once lipid levels normalize?

Bempedoic acid is an oral, first-in-class ATP-citrate lyase (ACL) inhibitor approved for the adjunctive treatment of hypercholesterolemia. It works upstream of HMG-CoA reductase in the cholesterol biosynthesis pathway—distinct from statins—and lowers low-density lipoprotein cholesterol (LDL-C) by approximately 15–25% when used alone, with greater reductions observed in combination with ezetimibe or statins.

Clinical evidence supports chronic use: LDL-C reduction is dose-dependent and reversible upon discontinuation. In pivotal trials such as CLEAR Harmony and CLEAR Wisdom, sustained efficacy was demonstrated over 52 weeks, and post-hoc analyses indicate that stopping therapy leads to a rapid rebound in LDL-C—typically returning to baseline within 4–6 weeks. Importantly, no trial has evaluated the safety or cardiovascular outcomes of intermittent or “on-demand” dosing.

Therefore, current guidelines—including those from the American College of Cardiology (ACC), American Heart Association (AHA), and European Society of Cardiology (ESC)—recommend continued pharmacologic therapy for patients at elevated atherosclerotic cardiovascular disease (ASCVD) risk, regardless of whether LDL-C reaches target levels. This reflects the principle that lipid-lowering medications exert pleiotropic effects beyond cholesterol reduction, including anti-inflammatory and plaque-stabilizing actions.

Discontinuation should never be undertaken without physician consultation. Abrupt cessation may not only reverse lipid benefits but also potentially increase residual cardiovascular risk—particularly in high- or very-high-risk individuals. Decisions about therapy duration must be individualized, weighing ASCVD risk burden, treatment tolerability, adherence, and shared decision-making with the patient.