New generation drugs for cholesterol, fatty liver & kidney disease, and what they promise

Bad cholesterol (LDL) is dangerous as it builds up in arteries, narrowing them and increasing the risk of heart attack and stroke. For a long time, statins (like Lipitor and Crestor) were the only main option, but now, for those with high cholesterol levels despite use of statins, PCSK9 inhibitors is being considered as an option.

The liver acts like a vacuum cleaner, clearing LDL cholesterol from the blood. PCSK9 inhibitors block the protein that disables this cleaner, helping liver keep blood cholesterol in check.

Evolocumab (Repatha)

Repatha is the lead the PCSK9 inhibitor class, helping the liver clear LDL cholesterol more effectively. In India, Repatha is marketed by Dr Reddy’s under a license from Amgen. The drug is priced Rs 19,000-21,000 per injection, with two doses a month costing over Rs 30,000.

Sanofi-Regeneron’s Praluent (Alirocumab) is not yet launched in India, it works similar to Repatha.

Inclisiran (Leqvio) - twice a year shots

A breakthrough option is Inclisiran (Leqvio) from Novartis, marketed locally under brands like Sybrava (Novartis), Crenzlo (Mankind Pharma), Izirize (JB Chemicals), and Tilpazan (Lupin). This siRNA (small interfering RNA) therapy requires only two doses a year, priced at Rs 1.2 lakh per shot, though “Buy 1 Get 1” schemes and EMI plans can halve the effective cost.

Instead of blocking the PCSK9 protein after it's made like evolocumab  and alirocumab, Inclisiran stops liver from making the protein in the first place, and acts like a software update for the liver.

Merck (MSD) is developing an oral PCSK9 pill, Enlicitide (MK-0616), now in Phase 3 trials, while gene-editing therapies from CRISPR Therapeutics and Verve Therapeutics remain in early stages against bad cholesterol.

Fatty liver disease (MASLD/MASH)

Fatty liver which is another major chronic disease in India, is caused due to excess fat in the liver leading to inflammation and scarring (fibrosis), which may progress to cirrhosis, liver failure, or increase the risk of liver cancer and heart disease. For a long time, there were no specific drugs for Fatty Liver (now often called MASLD) or its more severe form, MASH (formerly NASH). In 2024–25, this changed completely, and we now have the first specific drug approved globally, along with powerful weight-loss drugs that double as liver treatments.

Resmetirom (Rezdiffra)

Resmetirom (from Madrigal Pharmaceuticals) is the first drug in history explicitly approved by the USFDA last year to treat liver scarring (fibrosis) caused by fatty liver.

It works by targetting a thyroid hormone receptor in liver to burn off liver fat and heal scars.  Additionally, it also reduces LDL cholesterol (bad cholesterol) and triglycerides. The once a daily pill is not yet launched in India, it can be imported legally. Morepen, Dr Reddy’s, Mankind, among others are looking to launch the drug once the main patent expires in 2026.

GLP-1 drugs

GLP-1 drugs such as Novo Nordisk’s Semaglutide (brands Ozempic, Wegovy, Rybelsus) and Eli Lilly’s Tirzepatide (Mounjaro), originally for diabetes and weight loss, also clear liver fat. Rybelsus costs Rs 10,000–12,000 monthly, while injectables exceed Rs 20,000.

India’s own Zydus Lifesciences offers Saroglitazar (Lipaglyn) for NASH at Rs 1,500–2,000 per month, a cost-effective alternative.

Chronic Kidney Disease (CKD)

CKD is primarily caused by diabetes and high blood pressure and is considered a "silent killer" because it often has no obvious symptoms until significant, irreversible damage has occurred. India is considered to be the diabetes capital of the world, and many who don't manage properly are at risk of kidney failure, either requiring routine dialysis or expensive kidney transplant, both financially draining options. With lifestyle changes and some drugs, one can slow the progression of kidney failure or treat symptoms of the patients.

SGLT-2

CKD treatment has advanced with AstraZeneca’s Dapagliflozin (Forxiga) and Boehringer Ingelheim’s Empagliflozin (Jardiance), which lower kidney pressure and slow damage. Innovator brands cost Rs 1,400-1,600 per month, while Indian generics are available for Rs 150-300.

Finerenone (Kerendia) -- Bayer’s finerenone - a non-steroidal MRA, it blocks mineralocorticoid receptors specifically in the kidney to stop scarring (fibrosis) and inflammation. It is like putting a fire extinguisher on kidney inflammation. The drug is priced at Rs 1,400-1,800 monthly.

Others therapies

GLP-1s like semaglutide also protect kidneys. Zydus Lifesciences’ Desidustat (Oxemia), a pill for CKD-related anemia, priced at Rs 1,500-2,000 per month. A recent launch by AstraZeneca and Sun Pharma introduces Sodium Zirconium Cyclosilicate which rapidly lowers dangerous potassium levels, enabling patients to continue life-saving therapies.