[PCSK9 inhibitors : Recommendations for patient selection].

Area of Science:

• Cardiovascular Medicine
• Pharmacology

Background:

• Elevated low-density lipoprotein cholesterol (LDL-C) is a major cardiovascular risk factor.
• Statins and ezetimibe are standard lipid-lowering therapies, but some patients require additional treatment.
• Proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors represent a novel therapeutic class.

Purpose of the Study:

• To evaluate the efficacy and safety of subcutaneous PCSK9 inhibitors (alirocumab and evolocumab).
• To assess the role of PCSK9 inhibition in patients with refractory hypercholesterolemia.
• To identify patient populations who may benefit most from PCSK9 inhibitor therapy.

Main Methods:

• Subcutaneous administration of alirocumab or evolocumab every 2 or 4 weeks.
• Addition of PCSK9 inhibitors to maximally tolerated statin and/or ezetimibe therapy.
• Assessment of LDL-C reduction and safety profile compared to placebo.

Main Results:

• PCSK9 inhibitors reduced LDL-C by 50-60% in addition to existing therapies.
• The therapies were well-tolerated, with a safety profile comparable to placebo in published studies.
• Long-term outcome data and cardiovascular event information are pending from ongoing trials.

Conclusions:

• PCSK9 inhibitors are a safe and effective option for selected high-cardiovascular-risk patients with persistently high LDL-C.
• Ideal candidates include patients with familial hypercholesterolemia and those experiencing statin-associated muscle symptoms (SAMS).
• Further data on long-term safety and cardiovascular outcomes are anticipated.