Don't we forget about biological therapy of hypercholesterolemia with PCSK9-inhibitors?
Authors:
Vladimír Soška 1,2; Ondřej Kyselák 1,3
Authors‘ workplace:
Oddělení klinické biochemie, FN u sv. Anny v Brně
1; II. interní klinika, Lékařská fakulta MU, Brno
2; Katedra laboratorních metod, Lékařská fakulta MU, Brno
3
Published in:
Vnitř Lék 2021; 67(3): 138-142
Category:
Review Articles
Overview
In many patients it is difficult to achieve the current very low target LDL-cholesterol levels, recommended for the prevention of atherosclerotic cardiovascular events. If statin therapy or statins in combination with ezetimibe are not sufficient, addition of PCSK9 inhibitors should be considered. PCSK9 inhibitors reduce LDL-CH by an average of 50–60 % and reduce the risk of atherosclerotic cardiovascular events. They are currently reserved for patients with atherosclerotic cardiovascular disease and for patients with familial hypercholesterolaemia, in whom despite intensive hypolipidemic therapy statins with ezetimibe the target LDL-cholesterol value is not reached. In these patients, PCSK9 inhibitors may also be indicated in case of statin intolerance.
Keywords:
atherosclerotic cardiovascular disease – familial hypercholesterolemia – LDL-cholesterol – statins – PCSK9-inhibitors
Sources
1. Ference BA, Ginsberg HN, Graham I et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J 2017; 38: 2459–2472.
2. Boren J, Chapman MJ, Krauss RM et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J 2020; 41: 2313–2330.
3. Piepoli MF, Hoes AW, Agewall S et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis 2016; 252: 207–274.
4. Mach F, Baigent C, Catapano AL et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2019; 41: 111–188.
5. Awan Z, Baass A, Genest J. Proprotein convertase subtilisin/kexin type 9 (PCSK9): lessons learned from patients with hypercholesterolemia. Clin Chem 2014; 60: 1380–1389.
6. Navarese EP, Kolodziejczak M, Schulze V et al. Effects of Proprotein Convertase Subtilisin/ Kexin Type 9 Antibodies in Adults With Hypercholesterolemia: A Systematic Review and Meta-analysis. Ann Intern Med 2015; 163: 40–51.
7. Ling H, Burns TL, Hilleman DE. An update on the clinical development of proprotein convertase subtilisin kexin 9 inhibitors, novel therapeutic agents for lowering low-density lipoprotein cholesterol. Cardiovasc Ther 2014; 32: 82–88.
8. Koren MJ, Giugliano RP, Raal FJ et al. Efficacy and safety of longer-term administration of evolocumab (AMG 145) in patients with hypercholesterolemia: 52-week results from the Open-Label Study of Long-Term Evaluation Against LDL-C (OSLER) randomized trial. Circulation 2014; 129: 234–243.
9. Li C, Lin L, Zhang W et al. Efficiency and safety of proprotein convertase subtilisin/kexin 9 monoclonal antibody on hypercholesterolemia: a meta-analysis of 20 randomized controlled trials. J Am Heart Assoc 2015; 4: 1–14.
10. Raal FJ, Giugliano RP, Sabatine MS et al. Reduction in lipoprotein(a) with PCSK9 monoclonal antibody evolocumab (AMG 145): a pooled analysis of more than 1,300 patients in 4 phase II trials. J Am Coll Cardiol 2014; 63: 1278–1288.
11. Schwartz GG, Steg PG, Szarek M et al. Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome. N Engl J Med 2018; 379: 2097–2107.
12. Sabatine MS, Giugliano RP, Keech AC et al. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N Engl J Med 2017; 376: 1713–1722.
13. Labos C, Brophy JM, Sniderman A et al. Mortality Benefit of Alirocumab: A Bayesian Perspective. J Am Heart Assoc 2019; 8(20): e013170.
14. Praluent. https://www.sukl.cz/modules/medication/detail.php?code=0186946&tab=- prices.
15. Repatha. https://www.sukl.cz/modules/medication/detail.php?code=0186946&tab=- prices.
16. Lipinski MJ, Benedetto U, Escarcega RO et al. The impact of proprotein convertase subtilisin-kexin type 9 serine protease inhibitors on lipid levels and outcomes in patients with primary hypercholesterolaemia: a network meta-analysis. European Heart Journal 2016; 37: 536–U103.
17. Robinson JG, Farnier M, Krempf M et al. Efficacy and Safety of Alirocumab in Reducing Lipids and Cardiovascular Events. New England Journal of Medicine 2015; 372: 1489–1499.
18. Sabatine MS, Giugliano RP, Wiviott SD et al. Efficacy and safety of evolocumab in reducing lipids and cardiovascular events. N Engl J Med 2015; 372: 1500–1509.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2021 Issue 3
Most read in this issue
- What's new in the 2020 update of the CEAP classification system of chronic venous disease?
- Vericiguat in patients with heart failure and reduced ejection fraction
- The use of moxonidine in the treatment of arterial hypertension
- Treatment strategies for myelodysplastic syndrome in 2021