Inclisiran versus alirocumab in improving lipid profile parameters: A systematic review and meta-analysis

Dyslipidemia is a risk factor for cardiovascular diseases. Some patients are resistant to conventional treatment. In these patients, there is the possibility of using PCSK9 inhibitors. The objective of this systematic review was to compare alirocumab with inclisiran in improving the lipid profile.

This study was carried out in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols Statement (PRISMA) and registered with PROSPERO (CRD42024563261). The following databases were accessed on 2 July 2024: PubMed, Scopus and Web of Science. Clinical trials that evaluated the lipid profile were included. With these data, meta-analyses were carried out seeking to evaluate the difference between the baseline and the 12- and 24-week endpoints.

Initially, 1157 studies were found, of which 32 were included. In total, 30 718 patients participated in the included studies. There was a statistically significant difference, favouring alirocumab 75 mg (-51.54%, 95% confidence interval [CI] -53.43%; -49.66%), in relation to inclisiran 300 mg (-41.34%, 95% CI -50.30%; -31.34%) in reducing low-density lipoprotein cholesterol (LDL-C) (p = 0.05), in relation to inclisiran 200 and 300 mg in reducing total cholesterol (p < 0.01) (p < 0.01) and triglycerides (p = 0.02) (p = 0.04) in 24 weeks. Furthermore, alirocumab 150 mg was superior to both doses of inclisiran in reducing total cholesterol (p < 0.01) (p < 0.01). There was no statistically significant difference in the reduction of lipoprotein(a) by alirocumab 75 mg (-22.35%, 95% CI -24.67; -20.03) and 150 mg (-25.17%, 95% CI -30.94; -19.41) compared to inclisiran 300 mg (-13.37, 95% CI -28.66; 1.93) (p = 0.26) (p = 0.16).

Alirocumab was superior to inclisiran in improving the lipid profile, especially in reducing LDL-C, total cholesterol and triglycerides.