Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

LDL-C Reduction with Evolocumab & PCSK9 Inhibitors

J Am Heart Assoc; ePub 2017 Oct 2; Toth, et al

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. This according to a systematic review and meta-analysis of randomized trials of lipid-lowering therapies from database inception through 2016. 69 trials were found, of which 15 could be relevant for inclusion in LDL-C reduction networks with evolocumab, alirocumab, ezetimibe, and placebo as treatment arms. 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.

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.

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