Impact of PCSK9 inhibitors Alirocumab and Evolocumab on total & LDL cholesterol in clinical practice (2017)

Type of publication:
Conference abstract

*Capps N.

Atherosclerosis Supplements; 2017; vol. 28, e13

Background: The PCSK9 inhibitors Alirocumab (Al) and Evolocumab (Ev) were recently recommended for use in the NHS on the basis of NICE TA393 and 394 respectively. Clinical trials of both drugs show rapid, significant and continued reductions in total (TC) and LDL cholesterol (LDLC), however confirmation of their efficacy in UK clinical practice is required. Methods: The first patients in the hospital lipid clinic treated with Al 75 mg (14) or Ev 140 mg (13), with pre and post initiation (after 2-3 injections) fasting bloods, were evaluated. All results are in mmol/L. Results: 19 patients had Familial Hypercholesterolaemia, 9 classed by NICE as high or very high risk. Of the remaining 8 patients 5 were HR and 3 VHR. Overall mean TC and LDLC fell from 7.83 to 5.04 and 5.8 to 3.0, ie by 36 and 48%. For Alirocumab 75 mg mean TC and LDLC fell from 8.21 to 5.71 and 6.20 to 3.48, ie by 30 and 44%; individual reductions were 10 to 45% for TC and 13 to 62% for LDLC. For Evolocumab 140 mg mean TC and LDLC fell from 7.41 to 4.32 and 5.33 to 2.44, reductions of 42 and 54%; individual reductions were 32 to 55% for TC and 45 to 69% for LDLC. LDLC fell below 2.0 in 6 patients (Al 1, Ev 5), the lowest to 1.4 mmol/L. Conclusions: The data confirm the rapid and significant reductions in TC and LDLC with Al and Ev in previously difficult to treat patients, however many still had LDLC higher than ideal. This cohort did not contain patients treated with 150 mg Al, or by both drugs, so a direct comparison is not reported.