Want to lower LDL Cholesterol further, add Evolocumab & PCSK9 Inhibitors

Patients who need additional lowering of low‐density lipoprotein‐cholesterol (LDL‐C) despite statin therapy may benefit from additional lipid‐lowering therapy such as evolocumab or alirocumab (proprotein convertase subtilisin/kexin type 9 inhibitors [PCSK9]).

In a systematic review and meta-analysis of randomized trials of lipid-lowering therapies from database inception through 2016. 69 trials ,it has been found that when added to medium- to high-intensity statin therapy, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, specifically evolocumab, significantly reduced low-density lipoprotein cholesterol (LDL-C) in patients requiring further LDL-C reduction. The network meta-analysis showed a significant treatment difference in LDL-C reduction for evolocumab versus alirocumab .Studies of PCSK9 inhibitors in a range of populations and risk profiles have consistently showed a substantial relative reduction in LDL‐C additional to that provided by statins—often more than 60%, as shown in the present analysis.The findings have been published in Journal of American Heart Association.

PP Toth et al conducted a systematic review and meta-analysis of randomized trials of lipid-lowering therapies in 69 trials from database inception. Out of them 15 could be relevant for inclusion in LDL-C reduction networks with evolocumab, alirocumab, ezetimibe, and placebo as treatment arms.The researchers found:

• PCSK9 inhibitors significantly reduced LDL-C by 54% to 74% vs placebo and 26% to 46% vs ezetimibe.


• There were significant treatment differences in LDL-C reduction for evolocumab 140 mg every 2 weeks at the mean of weeks 10 and 12 vs placebo (‒74.1%), alirocumab 75 mg (‒20.03%), and alirocumab 150 mg (‒13.63%) at ≥12 weeks.


• Treatment differences were similar in direction and magnitude for PCSK9 inhibitor monthly dosing.

Adverse events were similar between PCSK9 inhibitors and control and vs placebo or ezetimibe.

Such incremental LDL‐C reduction can allow patients with high unmet need (eg, those at very high cardiovascular risk) to achieve LDL‐C levels below target, which is expected to reduce their residual risk of cardiovascular events.

Citation:

Toth PP, Worthy F, Gandra SR, et al. Systematic review and network meta-analysis of the efficacy of evolocumab and other therapies for the management of lipid levels in hyperlipidemia. [Published online ahead of print October 2, 2017]. J Am Heart Assoc. doi:10.1161/JAHA.116.005367.