Alirocumab in a high cardiovascular risk patient on hemodialysis with liver abnormalities

Area of Science:

• Cardiology
• Nephrology
• Pharmacology

Background:

• Type 2 diabetes mellitus and hemodialysis (HD) patients often have high cardiovascular disease (CVD) risk and hyperlipidemia.
• Standard lipid-lowering therapies like statins and ezetimibe may be contraindicated due to potential hepatotoxicity, particularly in patients with liver abnormalities such as chronic hepatitis C virus infection.

Observation:

• A male type 2 diabetic patient on hemodialysis with high CVD risk and hyperlipidemia discontinued statin and ezetimibe therapy due to chronic hepatitis C.
• Alirocumab, a PCSK9 inhibitor with no reported hepatotoxic effects, was administered at 150 mg every two weeks for eight weeks as an alternative treatment.

Findings:

• Treatment with alirocumab resulted in a significant decrease in low-density lipoprotein (LDL) levels.
• No adverse side effects were observed during the eight-week treatment period.

Implications:

• Alirocumab is a safe and effective alternative for managing hyperlipidemia and reducing CVD risk in hemodialysis patients with liver abnormalities.
• PCSK9 inhibitors should be considered a first-line treatment option for cholesterol lowering in this specific high-risk patient group.