Low-density lipoprotein cholesterol lowering in real-world patients treated with evolocumab

Area of Science:

• Cardiovascular Medicine
• Pharmacology
• Real-World Evidence

Background:

• Low-density lipoprotein cholesterol (LDL-C) is a key risk factor for atherosclerotic cardiovascular disease (ASCVD).
• Limited real-world data exist on the effectiveness of evolocumab in lowering LDL-C within the United States clinical practice.
• Understanding LDL-C reduction in routine care is crucial for managing ASCVD risk.

Purpose of the Study:

• To assess the efficacy of evolocumab in reducing LDL-C levels over a one-year period in a real-world US patient population.
• To evaluate the durability of LDL-C lowering effects of evolocumab.
• To compare real-world outcomes with findings from the FOURIER clinical trial.

Main Methods:

• Retrospective cohort study utilizing linked laboratory and medical claims data.
• Inclusion criteria: first fill of evolocumab between July 2015 and October 2019, with baseline LDL-C ≥ 70 mg/dL.
• Analysis included an overall cohort (N=5897) and a subgroup with recent myocardial infarction (N=152).

Main Results:

• Evolocumab treatment resulted in a 60% reduction in LDL-C in the overall cohort (median 146 to 58 mg/dL) and a 65% reduction in the recent MI subgroup (median 137 to 48 mg/dL).
• Over 62% of patients in the overall cohort and nearly 70% in the MI subgroup achieved LDL-C < 70 mg/dL.
• These LDL-C reductions were sustained throughout the one-year follow-up period.

Conclusions:

• Evolocumab demonstrated significant and durable LDL-C reductions in a real-world US setting.
• The observed LDL-C lowering was comparable to the efficacy reported in the FOURIER clinical trial.
• These findings support the use of evolocumab for managing LDL-C in patients at high cardiovascular risk in routine clinical practice.