Background and importance Hypercholesterolaemia is a well established risk factor for developing coronary heart disease and increasing the risk of cardiovascular events (RCE). Alirocumab and evolocumab, proprotein convertase subtilsin-kexin type 9 (PCSK9) inhibitors, can complement the management of patients who do not achieve target cholesterol levels with standard treatment or are intolerant to it.
Aim and objectives To evaluate the effectiveness of alirocumab and evolocumab in reducing low density lipoprotein cholesterol (LDL-c) and RCE in patients with poorly controlled hyperlipidaemia.
Material and methods This was an observational and retrospective study which included every patient treated with alirocumab and evolocumab between March 2016 and September 2019. Demographics and clinical variables were collected from the electronic medical records: sex, age, drug, dose, frequency of administration, previous hypolipaemic treatment, causes of suspension and analytical parameters at the start of treatment, and after 12 weeks and 24 weeks (total cholesterol (TC), LDL-c, high density lipoprotein (HDL)-cholesterol and triglycerides). To assess RCE, the Framingham scale was used, and if patients were diabetic or smokers was also recorded. To assess effectiveness, we calculated the percentage reduction (PR) of TC, LDL-c and RCE. Adverse effects (AE) were recorded to assess safety.
Results Forty-six patients were included (76% men, average age 60.8 (SD 11.1) years: 24 were treated with alirocumab and 22 with evolocumab. Median duration of treatment was 27.2 months (0.2–43.8). At drug initiation, 71.7% of patients were on high dose statins and 76.1% were on ezetimibe as an adjuvant. Six patients discontinued treatment: 4 for toxicity, 1 for associated pathology and 1 due to loss of follow up.
The mean baseline values for TC, LDL-c, HDL-cholesterol and triglycerides were, respectively: 237.6 (SD 79.5), 149.7 (SD 54.7), 52.3 (SD 13.9) and 166.2 (SD 111.5).
After 12 weeks of treatment, the PR in TC, LDL-c and RCE were 31.1%, 49.3% and 34.1%, and at 24 weeks, 29.9%, 43.7% and 32.8%, respectively. Eight patients recorded AE: 37.5% headache, 25% arthralgias, 25% flu-like syndrome, 12.5% hypertransaminasaemia and 12.5% syncope.
Conclusion and relevance PCSK9 inhibitors are an effective and safe therapeutic tool in the control of LDL-c and cardiovascular risk. In our patients, a more pronounced reduction in the parameters was observed in the first 12 weeks and was maintained afterwards. In addition, the results obtained were similar to those of clinical trials.
References and/or acknowledgements No conflict of interest.
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