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A register-based cohort study on the effectiveness and Safety of anti-PCSK9 treatment in persons with hyperlipidemia

Michael Asger Andersen1, Anne Helms Andreasen2, Lia Evi Bang3

  • 1Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark. michael.asger.andersen@regionh.dk.

Communications Medicine
|October 7, 2024
PubMed

Insights

This study found that switching between PCSK9 inhibitors alirocumab and evolocumab did not significantly alter low-density lipoprotein cholesterol (LDL-C) levels or major adverse cardiovascular events (MACE). Both drugs effectively reduce LDL-C, supporting their interchangeable use in dyslipidemia management.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Dyslipidemia is a significant cardiovascular disease risk factor.
  • Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are crucial for patients needing additional lipid-lowering therapy beyond statins.
  • Alirocumab and evolocumab are effective PCSK9 inhibitors, but direct comparative data is limited.

Purpose of the Study:

  • To assess the real-world effectiveness of PCSK9 inhibitors in reducing LDL-C levels.
  • To evaluate the impact of a mandated switch from alirocumab to evolocumab on LDL-C and clinical outcomes.
  • To analyze treatment retention and major adverse cardiovascular events (MACE) associated with these therapies.

Main Methods:

  • A register-based cohort study in Denmark (2016-2022) included 907 patients with dyslipidemia on PCSK9 inhibitors.
  • Analysis focused on LDL-C levels, treatment retention, and MACE.
  • Adjustments were made for age, sex, dosage, and concurrent lipid-lowering medications.

Main Results:

  • PCSK9 inhibitor treatment achieved a 49% reduction in LDL-C.
  • A mandated switch from alirocumab to evolocumab showed no significant difference in LDL-C levels or MACE.
  • Treatment discontinuation primarily occurred within 100 days, with no significant difference between the two drugs.

Conclusions:

  • Both alirocumab and evolocumab effectively reduce LDL-C in dyslipidemia patients.
  • The mandated switch between these PCSK9 inhibitors did not negatively impact LDL-C or clinical outcomes.
  • Findings suggest clinical equivalence and interchangeable use of alirocumab and evolocumab, aiding therapeutic decisions.
Abstract

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